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Using Multi-fluorinated Bile Acids and In Vivo Magnetic Resonance Imaging to Measure Bile Acid Transport
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Functional Gallbladder Disorders: Are We Missing Gallstones?

Tan Jun Guang Kendric1, Sharie Ann Apikotoa1, Zi Qin Ng1

  • 1General Surgery Registrar, St John of God Midland Hospital, Midland, Western Australia, Australia.

World Journal of Surgery
|January 8, 2026
PubMed
Summary
This summary is machine-generated.

Functional gallbladder disorder (FGBD) diagnosis can miss gallstones. Histopathology revealed gallstones in 18.5% of patients with FGBD, highlighting imaging limitations for biliary pain.

Keywords:
cholelithiasisfunctional gallbladder disorderhepatobiliary iminodiacetic acid scanultrasound

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Area of Science:

  • Gastroenterology
  • Hepatology
  • Diagnostic Imaging

Background:

  • Functional gallbladder disorder (FGBD) is diagnosed via ROME IV criteria, involving biliary pain without gallstones but with low gallbladder ejection fraction.
  • Histopathological analysis sometimes reveals cholelithiasis (gallstones) in patients diagnosed with FGBD.
  • This study quantifies missed gallstones in FGBD and aims to reduce misdiagnosis.

Purpose of the Study:

  • To quantify the incidence of histopathological cholelithiasis in patients diagnosed with functional gallbladder disorder.
  • To assess the impact of missed gallstones on FGBD diagnosis and patient outcomes.
  • To highlight the limitations of preoperative imaging in identifying gallstones in patients with biliary pain.

Main Methods:

  • A retrospective cohort study of 484 patients undergoing hepatobiliary iminodiacetic acid (HIDA) scans between November 2015 and April 2024.
  • Analysis of patients diagnosed with FGBD preoperatively.
  • Review of histopathological findings post-cholecystectomy and patient symptom resolution.

Main Results:

  • 5.6% of patients were diagnosed with FGBD preoperatively.
  • 18.5% of these patients had histopathological cholelithiasis despite preoperative imaging suggesting otherwise.
  • 70% of patients with true gallbladder dysfunction experienced symptom resolution after cholecystectomy.

Conclusions:

  • Functional gallbladder disorders are a notable cause of undifferentiated abdominal pain.
  • Microlithiasis (tiny gallstones) can be missed in up to 1 in 5 patients by preoperative imaging.
  • Considering functional aspects of biliary pain and awareness of imaging limitations are crucial to reduce morbidity from false negatives.