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Pain in the biliary tract is assumed to originate from either an obstructive event (the gall bladder contracting on a closed cystic duct, blocked by a gall stone) or inflammation (cholecystitis). Neither situation should be present after the gall bladder is extricated yet pain may persist.
The “post cholecystectomy syndrome” is a poorly defined entity which includes many symptoms that range from the trivial (mild dyspepsia) to severe attacks of abdominal pain and jaundice.1 Depending on the original indication for surgery, 20–50% of patients after cholecystectomy continue to have a variety of non-specific abdominal symptoms such as flatulence and dyspepsia.2-4 True biliary type pain occurs as a relatively small percentage (14%) of symptoms which follow cholecystectomy.5 From a different perspective, such pain following cholecystectomy was a complaint in only 0.6% of men and 2.3% of women in a household survey.6 When symptoms persist following cholecystectomy and no organic basis is evident (from a stricture, retained common duct stone, pancreatitis, tumour, or congenital anomaly) by default the basis becomes “functional”. With the gall bladder gone and the bile ducts (which lack a smooth muscle layer) acting as a simple conduit, the sphincter of Oddi (SO) becomes the prime suspect for the pain through spasm or biliary obstruction. The sphincter, strategically located at the junction of the biliary tract, pancreas, and duodenum, is like a …