Gallbladder dyskinesia in a 10 year old - Forum

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Pediatrician

Gallbladder dyskinesia in a 10 year old - Ärzteforum

Post#1 »

Gallbladder dyskinesia seems to be an increasingly more common diagnosis being seen in the surgeons office in recent years, particularly with the advent of nuclear medicine hepatobiliary cholangiography and the use of CCK to calculate the GB ejection fractions. Most of these cases, however, are adults, usually age 20-50. Recently, I saw a 10 year old 75 lb girl with "classic" post-prandial biliary symptoms and a CCK-DISIDA scan demonstrating a GB ejection fractions of 0% and 34% on the low and high dose CCK, respectively. Her only "significant" past medical history is that of dermatomyositis for the past 2-3 years, previously treated with prednisone, but with only Plaquinel over the past year. I checked with the company that manufactures this medication and according to them GB dyskinesia is not one of the reported adverse reactions. Work-up has included: UGI-negative; nuclear med reflux study demonstrating 2 episodes of mild reflux over a 30 minute period. She hads had no improvement in her symptoms despite Tagamet therapy.

Any suggestions, other than eventually proceeding with a laparoscopic cholecystectomy?


Pediatric surg

Re: Gallbladder dyskinesia in a 10 year old - Ärzteforum

Post#2 »

Although I recently reviewed every study I could find regarding the likelihood of symptomatic relief after an abnormal CCK-(choose your letter)IDA scan, and reported to the North Carolina Surgical Association that a low ejection fraction, particularly if associated with reproduction of the pain, correlates well with relief of symptoms after cholecystectomy, two things come to mind:

1) Acalculous cholecystitis is _not_ a dangerous condition and therefore symptomatic treatment carries no risk.

2) He who operates on pain seldom finds it.

I tend to see patients for many years, and have not been able to match the results that I found in the literature.

Poland

Re: Gallbladder dyskinesia in a 10 year old - Ärzteforum

Post#3 »

Is it possible this patient has Sphinter of Oddi dysmotility? If so, ERCP w/ sphincterotomy may be preferable to lap choly.

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Surgeon

Re: Gallbladder dyskinesia in a 10 year old - Ärzteforum

Post#4 »

Did the nuclear test reproduce the symptoms?

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Sweden surgeon

Re: Gallbladder dyskinesia in a 10 year old - Ärzteforum

Post#5 »

My suggestion after managing more than 15 children with this condition is: check by gastric endoscopic biopsy that you are not dealing with H. Pylori, if negative, then go ahead and remove the GB by Lap.

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