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Biliary dyskinesia in children
Hossam S Al-Homaidhi1, Husam Sukerek, Michael Klein
1Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien St., Detroit, MI 48201, USA.
Insights
Biliary dyskinesia (BD) in children causes chronic abdominal pain. Cholecystectomy effectively relieved symptoms in pediatric patients with delayed gallbladder ejection fraction, indicating its therapeutic value.
Area of Science:
- Pediatric Gastroenterology
- Hepatobiliary Surgery
- Diagnostic Imaging
Background:
- Biliary dyskinesia (BD) is a recognized cause of chronic abdominal pain in adults, though less common in pediatric populations.
- Diagnosis in children can be challenging, often requiring exclusion of other causes of abdominal pain.
- Gallbladder dysfunction, specifically impaired emptying, is a key feature of BD.
Purpose of the Study:
- To review the diagnosis, treatment, and outcomes of pediatric patients with biliary dyskinesia.
- To evaluate the efficacy of cholecystectomy in managing chronic abdominal pain associated with BD in children.
- To assess the role of cholecystokinin-stimulated gallbladder ejection fraction in diagnosing BD.
Main Methods:
- Retrospective review of pediatric patients undergoing cholecystectomy for BD between March 1995 and October 2000.
- Inclusion criteria: chronic upper abdominal pain, normal ultrasonography, and delayed gallbladder ejection fraction (<35%) on CCK-HIDA scintigraphy.
- Data collected included symptom duration, diagnostic tests, surgical intervention (laparoscopic cholecystectomy), and patient outcomes.
Main Results:
- Ten pediatric patients (13.5%) underwent cholecystectomy for BD during the study period.
- Mean symptom duration was 22 months, with a range of 1-60 months.
- All patients experienced complete symptom relief following laparoscopic cholecystectomy, with a mean follow-up of 12.8 months.
Conclusions:
- Cholecystectomy should be considered for children presenting with chronic upper-abdominal pain and confirmed delayed gallbladder ejection fraction.
- Laparoscopic cholecystectomy is an effective and recommended surgical treatment for pediatric biliary dyskinesia.
- CCK-HIDA scintigraphy is crucial for diagnosing BD in children with unexplained abdominal pain.
Abstract:
Biliary dyskinesia (BD) is a well-recognized cause of chronic abdominal pain in adults, but is less common in children. We reviewed our experience with the diagnosis, treatment, and follow-up in a group of children treated with cholecystectomy from March 1995 to October 2000. We identified children with chronic upper abdominal pain, normal ultrasonography (US), and delayed cholecystokinin (CCK)-stimulated gallbladder emptying (<35%). All other diagnostic tests for their abdominal pain were reviewed. Their treatment, surgical intervention, and outcome were recorded. During the study period, 74 cholecystectomies were performed in our institution, 10 (13.5%) of them for BD. The duration of symptoms ranged between 1 and 60 months (mean 22). All patients had a normal plain abdominal radiograph, normal US, and delayed gallbladder ejection fraction (EF). All were treated by elective laparoscopic cholecystectomy. Symptoms were completely relieved in all patients during the follow-up period, which ranged between 9 and 24 months (mean 12.8). Cholecystectom should be considered in children with chronic upper-abdominal pain and delayed EF on CCK-HIDA scintigraphy. Laparoscopic cholecystectomy is the procedure of choice in these patients.