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Disease of the gallbladder in patients with normal cholecystograms
Insights
Gallbladder disease, including chronic cholecystitis and cholesterolosis, can be missed by imaging tests like cholecystography. Surgery may be beneficial even with normal imaging results for symptomatic patients.
Area of Science:
- Gastroenterology
- Diagnostic Imaging
Background:
- Gallbladder disease diagnosis traditionally relies on imaging techniques like cholecystography.
- These imaging methods are assumed to be highly sensitive for detecting gallbladder pathology.
Observation:
- A significant number of patients undergoing cholecystectomy had normal pre-operative cholecystograms.
- Chronic cholecystitis, gallstones, and acalculous cholesterolosis can evade detection via roentgenography.
- Six additional patients with normal cholecystograms underwent surgery within an eight-month period.
Findings:
- Gallbladder disease, including cholesterolosis, can be present despite normal cholecystograms.
- Cholecystectomy was performed on patients with palpable or non-palpable stones, and those with cholesterolosis.
- Histopathological examination confirmed cholesterolosis in patients without palpable gallstones.
Implications:
- Current imaging modalities may underestimate the prevalence of gallbladder disease.
- Symptomatic patients with suspected gallbladder disease may benefit from cholecystectomy even with normal imaging.
- Further research is needed to refine diagnostic strategies for gallbladder disorders.
Abstract:
In contrast with what has widely been assumed, disease of the gallbladder sometimes remains undertected by even repeated cholecystography or cholegraphy. Chronic cholecystitis, gallstones, and acalculous cholesterolosis can escape detection by roentgenography of the gallbladder. Of 4,000 patients subjected to cholecystectomy between 1962 and 1973, the cholecystogram had been normal in only two. The range of indications for the operation has since been widened. Patients with typical symptons of gallbladder disease or recurrent pancreatitis of unknown origin have been operated on despite a normal cholecystogram. Within as short a period as eight months, an additional six patients with a normal cholecstogram have been operated on at our hospitals. Treatment consisted of cholecystectomy also in the four patients in whom no stones could be palpated in the gallbladder. Gross and microscopic examination of the gallbladder in these patients revealed cholesterolosis. When last seen, seven of the eight patients were still symptom-free an average fifteen months after the operation.