Abstract
Gallbladder dyskinesia is defined as abnormal contractility of the gallbladder. This motility disorder of the biliary tree has not been extensively studied in the pediatric population. In this report we describe four patients presenting with chronic right upper quadrant abdominal pain who were evaluated with gallbladder emptying scans. Their mean age was 14.2±1.7 (range 11 to 18) years. All four patients were female. Abdominal complaints were prevalent for a mean of 6.3 ± 3.8 weeks. The following symptoms were also reported; nausea and vomiting in 3, epigastric pain in 2 and nocturnal pain in 2 patients. There was no clear correlation between the onset of the abdominal pain and the meals. No patients had pain radiating to the back or subscapular area. All patients had normal liver function tests initially. Evaluations included a normal abdominal ultrasound, upper G.I. series, and abdominal CT scan in all patients. Three patients had a normal upper endoscopy, with one patient demonstrating biopsy confirmed esophagitis. None of the patients were positive for Helicobacter pylori by serology, Clo-test or histology. Delayed gallbladder emptying was demonstrated utilizing cholescintigraphy with Tc99m Choletec. The mean ejection fraction measured in these patients was 12.9 ± 6.7%. Abnormal gallbladder ejection fractions after cholecystokinin were defined as less than 35% excretion. All 4 patients underwent laparoscopic cholecystectomy. Histology demonstrated mild chronic cholecystitis in all 4 patients. The mean follow-up was 13.0 ± 2.9 weeks (range 8 to 20 weeks). Three of the 4 patients have remained asymptomatic. One of the patients had a subsequent sphincterotomy because of persistent pain and elevated biliary pressure.In conclusion, delayed gallbladder emptying identified gallbladder dyskinesia in 4 of 4 children with chronic right upper quadrant pain. Symptoms resolved in 3 of 4 patients after cholecystectomy, while one patient required an endoscopic sphincterotomy. A gallbladder emptying study should be performed in children with right upper quadrant pain and negative routine evaluation.
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