I'm having the same symptoms that I had when I had my gallbladder removed more than five years ago. I have pain in the back of my right shoulder radiating toward the front. I also have heartburn and indigestion. My question is: Can the gallbladder grow back?

Glenna

No, the gallbladder cannot grow back. However, symptoms of recurrent pain after gallbladder-removal surgery (cholecystectomy) are not uncommon. This has been termed "post-cholecystectomy syndrome," and it occurs in 5-40 percent of cases in various studies.

The most common reason for removal of the gallbladder is pain, known as biliary colic. This pain, usually the result of gallstones, occurs intermittently in the upper abdomen (often on the right side) and lasts from several minutes to hours, sometimes with nausea and vomiting. Generally, removal of the gallbladder (and thus the stones) results in resolution of the pain.

There are several possible causes of recurrent pain after gallbladder-removal surgery. The first is that the symptoms were not related to the gallbladder. Many upper GI problems, such as ulcers or reflux, can cause symptoms mimicking gallbladder disease. If these symptoms are not carefully evaluated before the operation, then the gallbladder may be removed unnecessarily.

Another possible reason for recurrent pain is that another disease is present in the bile ducts that causes pain identical to that caused by gallstones. One such condition, called "sphincter of Oddi dysfunction," is an abnormality in the sphincter that allows bile to enter the intestine from the bile ducts. The sphincter is too tight, leading to painful, excess pressure in the ducts. This is a common disorder in young women with typical symptoms of biliary colic. Often their gallbladders are removed, sometimes even if no stones are found, and the diagnosis is only made later when further investigations reveal the high pressure in the sphincter.

Another explanation for recurrent pain after a cholecystectomy, especially if it appeared only after five years, is that more stones are present. Although stones usually form in the gallbladder, they can also form in the bile ducts, producing to the same symptoms. It may also be that a very tiny stone was left in the bile ducts at the time of surgery, and this stone has been slowly enlarging since. In rare cases, the duct leading into the gallbladder (the cystic duct) is not clamped and cut close to its base during the surgery. This can lead to an enlargement of the remaining part of the duct, which can also lead to more stone formation.

The bottom line is that many possibilities exist to explain recurrent pain after gallbladder surgery. Appropriate testing will usually lead to the answer. Your doctor can guide you through the appropriate tests.