Cystic Duct Stenting

[danggirl]

Hi. I'm hoping that all you GI nurse experts can help me out with this. I've never run across it in my career and I can't find hardly any information on it at all. A few weeks ago I had a stent put in my cystic duct (gallbladder removed many years ago) due to constant pain and recurring high fevers (103+) after the removal of a prior CBD stent. The theory is that "stuff" is getting trapped in the cystic duct causing the symptoms. The GI doctor said if it works then they would remove the remaining cystic duct with surgery.

Has anyone ever heard of this before? AND burning nurse question why do they leave the cystic duct stump there when removing a gall bladder if it just goes nowhere? Is it because of the risk of intestinal leaking? Any info y'all have would be great not just for me but also because I tend to take care of a lot of liver patients (when I'm working) and there is the potential that I'll run across it in someone else someday. Thanks!

[danggirl]

I made the original post back in October. I didn't get any replies but perhaps I can turn it into a teaching opportunity since I've learned a few things since then.

So the cystic duct is the one that the gallbladder is attached to and, due to some fancy physiology concerning sphincters and pressure and chemical signals, allows bile to be stored and/or released when needed. When one needs their gallbladder removed, the surgeon snips the cystic duct at about the halfway point between the gallbladder and the insertion into the common bile duct. So, there is a little piece of the cystic duct left over but this is usually extremely small and doesn't cause problems. Some people do encounter problems for some reason (Post Cholecystectomy Syndrome).

In my particular case...I'm deformed! My cystic duct is the same size as my common bile duct and instead of a normal attachment site on the CBD, mine attaches down by where the CBD empties into the intestines. I've had stents placed 3 times and had the whole set up dilated a time or two. As soon as the last stent came out (Nov 11th)...Nov 15th I was right back in the ER with high fever, vomiting, pain etc. They are not really clear why this is happening but they do have a solution (never heard of this):

They are going to cut out that offending stump of cystic duct, then cut out the CBD and perform a reconstruction of it using small intestine!! Fascinating.

So, if you get patients that have had their gallbladders removed but present with c/o that sound like a gallbladder attack....they have an actual problem...the nerves are still preserved and so the symptoms are similar if not the same. Occasionally people will have a retained or newly form stoned, or strictures from the previous surgery. They most likely will not have what I have (the doctors have never seen it before and they are top docs from Barnes-Jewish/Washington University in St Louis!

Anyway, hopefully someone learned a little something from this! I know patients get tired of being dismissed or told that they "shouldn't" have the symptoms they are reporting. Granted there are always people who manipulate the system to get what they want (including attention and medication) but, I think patients should be given the benefit of the doubt until a solution can be agreed upon...

[Alex Egan, LPN, EMT-B]

Nothing drops a person quicker than a gallbladder or a kidney stone. It's shocking the level of pain an debilitating symptoms come on with these diseases. Your case is unique and I'm glad you shared.