Chronic acalculous gallbladder disease: a clinical enigma.

Abstract

AbstractPatients with classic symptoms of gallbladder disease who have negative oral cholecystograms (OCG) or ultrasonography present perplexing management problems. The surgical literature attests to the fact that there is a marked difference of opinion as to the role of surgery in these patients. The high recurrence rate of symptoms in patients following surgery reported in some series has been a source of major concern.We have attempted to define the appropriate approach to this problem for the past decade. Initially, the findings of prolonged visualization of the gallbladder on OCG in association with a fatty meal was considered an indication for surgery. This initial group of patients followed over a decade showed about 75% to be symptom free. Subsequently, additional patients were subjected to cholecystokinin oral cholecystography (CCK‐OCG). With follow‐up for over 6 years, the results have shown about 80% relief of biliary tract symptoms in these patients (CCK‐OCG category) following surgery.Continued attempts to further define those patients who will benefit from surgery has resulted in the utilization of radionuclide imaging in association with cholecystokinin injection (CCK‐RNI). One hundred patients were subjected to CCK quantitative biliary imaging. Seventy‐six patients were considered to have inadequate gallbladder emptying; 30 patients with no gallbladder emptying on CCK‐RNI were subjected to cholecystectomy. All patients subjected to cholecystectomy showed abnormal histological findings in the gallbladder. These 30 patients have been followed from 1 to 3 1/2 years and there has been no recurrence of symptoms in any following surgery.