Hepatobiliary scintigraphy: Nonvisualization of activity in the area of the gallbladder associated with intestinal activity

Abstract

A 22-year-old, Mexican-American man presented to the emergency service with a two-day history of intermittent, right-upperquadrant (RUQ) pain and nausea, which began shortly after eating bacon and eggs. His past medical history was unremarkable. On physical examination, RUQ tenderness with a positive Murphy's sign was demonstrated. His laboratory data included: WBC 10,600 (normal 4-11,000/mm3), total bilirubin 1.8 (normal 0.2-1.2 mg/dL), SGOT 25 (normal 5-40 IU/ L), SGPT 20 (normal 5-40 IU/L), and serum amylase 11 (normal 2-20 IU/L). Interpretation of his ultrasonic examination was precluded because of interference by bowel gas. Hepatobiliary scintigraphy was requested upon admission. The patient had been fasting for at least two to three hours prior to the scintigraphic study (Fig 1). Shortly after the imaging studies, he was taken to the operating room. The omentum directly inferior to the gallbladder was cyanotic and swollen. The appendix, gallbladder, common bile duct, and small and large bowel appeared normal. A 6 x 6-cm portion of torsed omentum was removed and sent to surgical pathology: hemorrhagic and acutely inflamed omentum consistent with early infarct. The patient had several possible causes for gallbladder nonvisualization by scintigraphy: premature termination of the study, physiologic distension, nonbiliary inflammatory focus, and a remote possibility of asymptomatic chronic cholecystitis.