Refractory Hyperkinetic Biliary Colic: A Case of Biliary Dyskinesia

Biliary dyskinesia results from abnormal gallbladder motility, leading to a deviation from a physiologic biliary ejection fraction. It is classified into two types: hyperkinetic and hypokinetic. Hyperkinetic biliary dyskinesia is an uncommon condition that may present without symptoms. In clinical practice, some patients are noted to have elevated gallbladder ejection fractions, though only a minority are considered for intervention. Due to its rarity and variable presentation, there are currently no established guidelines for treatment. We present the case of a 48-year-old female with a year-long history of postprandial right upper quadrant (RUQ) pain, nausea, and weight loss, ultimately diagnosed with hyperkinetic biliary colic. Following a comprehensive evaluation, which included unremarkable imaging and a hepatobiliary iminodiacetic acid (HIDA) scan demonstrating 100% gallbladder ejection. In the following days, she underwent robotic-assisted cholecystectomy (RAC) with subsequent symptomatic improvement. This case highlights the diagnostic challenges, management considerations, and postoperative outcomes based on the detailed personal account in this rare clinical entity.