Abstract
We report our experience of cholecystectomy for treating symptoms suggestive of biliary disease in association with a decreased gallbladder ejection fraction (GBEF) but without evidence of cholelithiasis. Five children with normal biliary ultrasounds were evaluated between January 1990 and December 2000 for recurrent upper abdominal pain. Based on a cholecystokinin (CCK)-provoked GBEF of less than 50% and the absence of any other gastrointestinal pathology, patients underwent cholecystectomy with operative cholangiography for presumed biliary dyskinesia. Pathological examination demonstrated chronic inflammation in all cases. Two patients had complete resolution of their symptoms, but three had persistent pain following surgery. Biliary dyskinesia seems an uncommon cause of persistent abdominal pain in childhood. Cholecystectomy was not always effective in relieving symptoms. Biliary scintigraphy with CCK provocation should not be used as the sole criterion for cholecystectomy. Sphincteric manometry may be valuable in the assessment of this small group of patients to avoid inappropriate intervention. The future perhaps lies in better understanding of the physiological action and pharmacological control of the sphincter of Oddi.
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References
Al-Homaidhi HS, Sukerek H, Klein M, Tolia V (2002) Biliary dyskinesia in children. Pediatr Surg Int 18:357–360
Blades EW, Sivak MV (1993) Sphincter of Oddi manometry: how far is the leap of faith? Gastrointest Endosc 39:593–595
Blalock A (1924) A statistical study of eight hundred and eighty-eight cases of biliary tract disease. Johns Hopkins Hosp Bull 35:391–409
Broden B (1958) Experiments with cholecystokinin in cholecystography. Acta Radiol 49:25
Canfield AJ, Hetz SP, Schriver JP, et al (1998) Biliary dyskinesia: a study of more than 200 patients and review of the literature. J Gastrointest Surg 2:443–448
Courtney DF, Clanachan AS, Scott, GW (1983) Cholecystokinin constricts the canine cystic duct. Gastroenterology 85:1154–1159
Dumont C, Caniano DA (1999) Hypokinetic gallbladder disease: a cause of chronic abdominal pain in children and adolescents. J Pediatr Surg 34:858–862
Fink-Bennett D, DeRidder P, Kolozsi W et al (1985) Chlolecystokinin cholescintigraphic findings in the cystic duct syndrome. J Nucl Med 26:1123–1128
Freeman JB, Cohen WN (1975) Cholecystokinin cholangiography and the analysis of duodenal bile in the investigation of pain in the right upper quadrant of the abdomen without gallstones. Surg Gynecol Obstet 140:371–376
Gollin G, Raschbaum GR, Moorthy C (1999) Cholecystectomy for suspected biliary dyskinesia in children with chronic abdominal pain. J Pediatr Surg 34:854–857
Graham EA, Cole WA (1924) Roentgenologic examination of the gall bladder: Preliminary report of a new method utilising intravenous injection of tetrabromophenophthalein. JAMA 82:613–614
Hawkins PE, Graham FB, Holliday P, et al (1966) Gallbladder disease in children. Am J Surg 111:741–744
Hogan WJ, Geenen JE, Dodds WJ, et al (1982) Paradoxical motor response to cholecystokinin octapeptide (CCK-OP) in patients with suspected sphincter of Oddi dysfunction. Gastroenterology 82:1085
Ivy AC, Goldberg E (1928) A hormonal mechanism of gallbladder contraction and evacuation. Am J Physiol 86:599–613
King CE, Kalvaria I, Sninsky CA (1998) Pancreatitis due to endoscopic biliary manometry: proceed with caution. Gastroenterology 94: A227
Kracht M, Thompson JN, Bernhoft RA, et al. (1986) Cholangitis after endoscopic sphincterotomy in patients with stricture of the biliary duct. Surg Gynecol Obstet 163:324–326
Krishnamurthy GT, Bobba VR, Kingston E (1982) Optimisation of octapeptide of cholecystokinin (op-CCK) dose for gallbladder emptying. In: Raynaud C (ed) Proceedings of the third world congress of nuclear medicine and biology, Paris, France, 29 Aug–2 Sept 1982, Pergamon Press, pp 2224–2247
Krishnamurthy GT, Bobba VR, Kingston E (1982) Measurement of gallbladder emptying sequentially using a single dose of 99mTc-labeled hepatobiliary agent. Gastroenterology 83:773–776
Krishnamurthy S, Krishnamurthy GT (1997) Biliary dyskinesia: role of the sphincter of Oddi, gallbladder and cholecystokinin. J Nucl Med 38:1824–1830
Mackey WA (1934) Cholecystitis without stone. Br J Surg 22:274–295
Misra DC, Blossom GB, Fink-Bennett D, et al (1991) Results of surgical therapy for biliary dyskinesia. Arch Surg 126:957–960
Sherman S, Hawes RH, Troiano FP, et al (1992) Pancreatitis following bile duct sphincter of Oddi manometry: utility of the aspirating catheter. Gastrointest Endosc 38:347–350
Steigerwalt RW, Goldfine IID, Williams JA (1984) Characterisation of cholecystokinin receptors on bovine gallbladder membranes. Am J Physiol 247: G709-G714
Tsakayannis DE, Kozakewich HPW, Lillehei CW (1996) Acalculous cholecystitis in children. J Pediatr Surg 31:127–131
Whipple AO (1926) Surgical criteria for cholecystectomy. Am J Surg 40:129–139
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Wood, J., Holland, A.J.A., Shun, A. et al. Biliary dyskinesia: is the problem with Oddi?. Ped Surgery Int 20, 83–86 (2004). https://doi.org/10.1007/s00383-003-1092-4
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DOI: https://doi.org/10.1007/s00383-003-1092-4