Clinical Analysis of Breast Lactation after Laparoscopic Cholecystectomy in Nonlactation Period

Patient 1, female, 39‐year‐old, who was admitted because of iterative right upper abdominal pain for 9 days and aggravation for 3 h. Patient 2, female, 38‐year‐old, who was admitted because of right upper abdominal pain for 3 days. In two cases, physical examination showed right upper abdomen tenderness, mild rebound tenderness, liver percussion pain, and positive Murphy sign. B ultrasound showed gallbladder volume augmentation, acute cholecystitis, and stones in the gallbladder neck. Finally, we diagnosed it for acute supervening cholecystitis accompanying gallstones. Laparoscopic cholecystectomy was successfully executed in general anesthesia, and morphine was used by intravenous injection for analgesia after operation and patients rehabilitated well. But Patient 1 felt breast pain and lactated 5 ml milk from breast on the fourth day after operation, blood prolactin (PRL) 58.9 ng/ml (normal: 1.9–25.0 ng/ml), and Patient 2 felt breast pain and lactated 8 ml milk from breast on the third day after operation, blood prolactin (PRL) 48.6 ng/ml, and the milk was certified by smear observing under a microscope. Then, we did some checking and found that the pituitary was normal by head computed tomography check, and original gynecological disease was not found by gynecological examination. Hence, bromocriptine was administered, 2.5 mg, 2 times in a day for 2 weeks. Breast tenderness and lactation disappeared and PRL 8.3 ng/ml (Patient 1) and PRL 6.5 ng/ml (Patient 2) after 2 weeks. Finally, the patient was cured, and breast lactation did not occur in 1‐year follow‐up. Generation and secretion of milk were regulated by neuroendocrine factors such as endocrine, physiological, environmental, and genetic factors, and serum prolactin was a determinant factor of milk secretion quantity. Reasons for prolactin rise consisted of the following: (a) Physiological factors, such as pregnancy, lactation, low blood sugar. (b) Pathological factors: (1) Pituitary disease, such as prolactinoma, sella tumors, and cysts, promoted prolactin secretion by declining secretion of pituitary gonadotropin. (2) Hypothalamus and pituitary stalk disease, such as sarcoidosis, tuberculosis, craniopharyngioma, hamartoma, cranial irradiation, and empty sella, promoted prolactin secretion by blocking inhibitory effects of prolactin inhibitor factors on prolactin. (3) Primary or secondary hypothyroidism increased prolactin by raising thyrotropin‐releasing hormone and thyroid‐stimulating hormone. (4) Liver dysfunction raised prolactin because of abnormal liver degradation of prolactin and kidney dysfunction due to renal metabolism slows down. (5) Polycystic ovary syndrome promoted secretion of prolactin because secondary estrogen induced synthesis of prolactin cells. (6) Ectopic prolactin secretion, such as bronchial tumor and hypernephroma. (7) Acromegaly: 50% of patients with growth hormone adenomas were associated with hyperprolactinemia.[1] (c) Drug factors, some drugs increased secretion of prolactin by antagonizing prolactin release inhibitory factor and increasing prolactin‐releasing Clinical Analysis of Breast Lactation after Laparoscopic Cholecystectomy in Nonlactation Period