Atypical Case of Post Cholecystectomy Patient with Chronic Diarrhea

Introduction: Diarrhea is a common gastrointestinal complaint. One culprit that may often go overlooked is bile induced diarrhea, which is often proceeded by a prior cholecystectomy. There are approximately 300,000cholecystectomies performed annually in the U.S. Up to 20%of people undergoing gallbladder surgery develop diarrhea however this normally stops soon after the surgery. Rarely, will it last for years. Cholestyramine, a bile acid binder, has proven to be an effective medication for bile acid induced diarrhea. Here we present a case of post cholecystectomy diarrhea.Case: 70-year-old female with a past medical history of mixed hyperlipidemia, diverticulitis, and post-cholecystectomy 38years ago developed episodes of diarrhea 29years post-procedure. She had been having ongoing episodes of diarrhea and abdominal pain with some episodes being so intense it caused her to lose consciousness and one resulted in a fractured femur. She reports losing up to 50pounds due to her diarrhea. Patient had tried Imodium and dicyclomine in the past with minor relief. Patient was started on Cholestyramine 4gram packets daily as needed which resolved her symptoms of diarrhea and abdominal pain. Conclusion: With cholecystectomies being common procedures in the U.S., it is important for physicians to keep bile acid induced diarrhea in the differential diagnosis when treating chronic diarrhea in patients. Our case presented unusually in the aspect that the patient's diarrhea episodes occurred years after her cholecystectomy with such a long duration spanning over years however like the majority of bile acid induced diarrhea, it responded well to cholestyramine.