Management of the Hyperkinetic Gallbladder in Adults: A Case Series

Lawrence N Cetrulo, MD, Amit Joshi, MD, FACS, Albert Trang, MD. Einstein Healthcare Network

The primary indications for laparoscopic cholecystectomy are stone related diseases in adults. A subset of patients who require surgery carry a diagnosis of biliary dyskinesia, usually defined as an ejection fraction on Cholecystokinin hpeatobiliary iminodiacetic acid exam (CCK-HIDA). In children, the primary indication for laparoscopic cholecystectomy is biliary dyskinesia. However, not only do patients have low ejection fractions, but a significant number have hyperactive ejection fractions, with and EF > 80%. There is well established research showing long term resolution of symptoms in children with hyperkinetic ejection fractions on CCK-HIDA. Here we will discuss a case series of adults receiving laparoscopic cholecystectomy for hyperkinetic biliary dyskinesia.

Four patients presented for biliary colic with workups revealing no signs of disease secondary to gallbladder sludge or stones. The only positive finding was an elevated ejection fraction on CCK-HIDA. These patients all had resolution of their symptoms immediately after surgery and at subsequent follow up visits 4 weeks after surgery. This disease process requires further analysis but this could represent a new indication for laparoscopic cholecystectomy in the adult population.

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