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Cholecystectomy for suspected biliary dyskinesia in children with chronic abdominal pain
G Gollin1, G R Raschbaum, C Moorthy
1Pediatric Surgical Associates of El Paso, TX 79902, USA.
Insights
Biliary dyskinesia, a cause of chronic abdominal pain in children without gallstones, is effectively treated by gallbladder removal (cholecystectomy). This procedure offers significant symptom relief for most pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Hepatobiliary Surgery
Background:
- Chronic abdominal pain in children often lacks a clear diagnosis.
- Gallbladder dysfunction, or biliary dyskinesia, is increasingly recognized in pediatric patients.
- Cholelithiasis (gallstones) is typically absent in these cases.
Purpose of the Study:
- To review the clinical experience with children suffering from chronic abdominal pain and delayed gallbladder emptying without gallstones.
- To investigate the diagnostic methods and the efficacy of cholecystectomy in managing these symptoms.
Main Methods:
- Twenty-nine children with suspected biliary dyskinesia underwent evaluation.
- Diagnosis involved upper abdominal pain, absence of gallstones on ultrasound, and a low gallbladder ejection fraction (<40%) after cholecystokinin stimulation.
- All diagnosed patients were treated with cholecystectomy.
Main Results:
- Patients experienced symptoms for 3 weeks to 4 years prior to surgery.
- Abdominal ultrasonography and cholecystokinin (CCK) cholescintigraphy were used for diagnosis.
- Seventy-nine percent (23/29) of children reported complete symptom relief post-cholecystectomy.
- Five children had persistent pain, and one experienced nausea.
Conclusions:
- Biliary dyskinesia is a common cause of biliary colic symptoms in children without gallstones.
- CCK cholescintigraphy is a crucial diagnostic tool for identifying biliary dyskinesia.
- Cholecystectomy is a highly effective treatment, with a majority of patients experiencing symptom resolution.
Background/Purpose:
The authors reviewed their experience with a group of children with chronic abdominal pain, delayed gallbladder emptying, and no cholelithiasis. Clinical presentation, diagnostic evaluation, and effect of cholecystectomy on symptoms were investigated.
Methods:
Twenty-nine children were suspected of having biliary dyskinesia. Diagnosis was based on symptoms of upper abdominal pain in conjunction with a lack of sonographically apparent gallstones, a cholecystikinin (CCK)-stimulated gallbladder ejection fraction of less that 40% at 30 minutes, and a lack of any other clear cause for symptoms. All patients underwent cholecystectomy.
Results:
The duration of symptoms before operation was between 3 weeks and 4 years. All patients were evaluated by abdominal ultrasonography and CCK cholescintigraphy. Symptoms were relieved completely in 23 (79%) of the patients who underwent cholecystectomy. Five children had persistent pain after cholecystectomy and one had nausea.
Conclusions:
Symptoms suggestive of biliary colic in children without evidence for cholelithiasis frequently may represent biliary dyskinesia. CCK cholescintigraphy should be pursued in these patients. Relief of symptoms after cholecystectomy should be expected in a majority of those with an ejection fraction of less that 40%.