Differential Diagnosis for RUQ Pain 2 Years After Cholecystectomy

Single Most Likely Diagnosis

• Biliary Dyskinesia or Sphincter of Oddi Dysfunction: This condition is a common cause of post-cholecystectomy pain, especially if the patient had a history of biliary colic or sphincter of Oddi dysfunction before the surgery. The pain is usually intermittent, located in the right upper quadrant (RUQ), and may be accompanied by nausea and vomiting.

Other Likely Diagnoses

• Adhesions or Adhesive Bowel Obstruction: Post-surgical adhesions can cause intermittent bowel obstruction, leading to RUQ pain, nausea, vomiting, and changes in bowel habits.
• Hepatic or Common Bile Duct Stones: Although less common after cholecystectomy, stones can still form in the bile ducts, causing obstructive jaundice, RUQ pain, and potentially life-threatening complications like cholangitis.
• Peptic Ulcer Disease: Gastric or duodenal ulcers can cause RUQ pain, especially if the patient has a history of NSAID use or Helicobacter pylori infection.
• Gastroesophageal Reflux Disease (GERD): GERD can cause epigastric and RUQ pain, especially if the patient experiences reflux of stomach contents into the esophagus.

Do Not Miss Diagnoses

• Hepatic Artery Thrombosis or Stenosis: Although rare, these conditions can cause severe RUQ pain, liver dysfunction, and potentially life-threatening complications, especially in patients with a history of liver transplantation or vascular disease.
• Cholangiocarcinoma: A rare but aggressive cancer that can cause obstructive jaundice, RUQ pain, and weight loss, often presenting several years after cholecystectomy.
• Pancreatic Cancer: A diagnosis that should not be missed, as it can cause RUQ pain, weight loss, and obstructive jaundice, especially in patients with a history of smoking or family history of pancreatic cancer.

Rare Diagnoses

• Primary Sclerosing Cholangitis: A rare autoimmune disease that causes chronic inflammation and scarring of the bile ducts, leading to RUQ pain, obstructive jaundice, and potentially life-threatening complications.
• Budd-Chiari Syndrome: A rare condition caused by thrombosis of the hepatic veins, leading to RUQ pain, liver dysfunction, and potentially life-threatening complications.
• Intrahepatic Shunt or Arteriovenous Malformation: Rare vascular anomalies that can cause RUQ pain, liver dysfunction, and potentially life-threatening complications.