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Chronically symptomatic patients with undetectable gall bladder on ultrasonography could benefit from early

Stephen D Adams1, Simon C Blackburn, Victoria A Adewole

  • 1Department of Paediatric Surgery, Royal Alexandra Children's Hospital, Eastern Road, Brighton BN2 5BE, UK.

Minimally Invasive Surgery
|February 13, 2013
PubMed

Insights

Gallbladder non-visualization on ultrasound may indicate chronic acalculous cholecystitis. Consider cholecystectomy for persistent biliary dyspepsia when the gallbladder is not seen on imaging.

Area of Science:

  • Gastroenterology
  • Diagnostic Imaging

Background:

  • Cholelithiasis is common in patients undergoing cholecystectomy, with gallbladders typically visible on ultrasonography.
  • Diagnosing symptomatic biliary dyspepsia in children is challenging when gallstones are absent and the gallbladder is not visualized on repeated imaging.

Purpose of the Study:

  • To investigate the significance of gallbladder non-visualization in pediatric patients with symptomatic biliary dyspepsia.
  • To determine if non-visualized gallbladders on ultrasonography correlate with chronic acalculous cholecystitis.

Main Methods:

  • Retrospective review of 54 cholecystectomy cases.
  • Identification of cases with recurrent right upper quadrant pain and undetectable gallbladders on repeat ultrasonography.
  • Histological examination of excised gallbladders.

Main Results:

  • Three cases presented with recurrent pain and non-visualized gallbladders on ultrasonography.
  • All three patients underwent successful cholecystectomy.
  • Histology revealed markedly fibrotic and thickened gallbladders in all identified cases.

Conclusions:

  • Non-visualization of the gallbladder on repeated ultrasonography may be a key feature of chronic acalculous cholecystitis.
  • Cholecystectomy should be considered for chronic biliary dyspepsia when ultrasonography fails to visualize the gallbladder.

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