Bala Thatigotla, MD MRCS. Bronx Lebanon Hospital Center, NY, USA
ABSTRACT TITLE: Biliary dyskinesia: An underdiagnosed condition. Evaluation of its implications .
INTRODUCTION: Biliary dyskinesia is a underdiagnosed condition. The lack of suspicion, leads to unnecessary investigations, and delay in diagnosis and operative management.
METHODS: A retrospective evaluation of 33 consecutive patients diagnosed with biliary dyskinesia between Jan 2006 and Jan 2010 was done.
RESULTS: 33 patients were diagnosed with biliary dyskinesia and all underwent laparoscopic cholecystectomy. Mean gallbladder ejection fraction was 10%. There were 32 females and 1 male. The mean age was 49 years (range: 22-78 years). Mean duration between symptoms and diagnosis was 11.4 months (range: 3-36 months). WBC and liver enzymes were normal in all patients. Mean BMI was 26 (range: 21-35). 26 CT scans, 45 ultrasounds, 12 upper GI endoscopies and 6 cardiac work ups were done before investigation for biliary dyskinesia was initiated. 31 patients (94%) had resolution of symptoms following laparoscopic cholecystectomy, while 2 patients (6%) required further evaluation of abdominal pain. Pathology showed signs of chronic cholecystitis in 29 patients, acute cholecystitis in 3 patients, and adenomatous hyperplasia in 1 patient. Gallstones were absent in all but two patients, both of whom had pathological findings of acute cholecystitis.
CONCLUSION(S): Symptoms of cholecystitis without gallstones should lead to suspicion of biliary dyskinesia. CCK-HIDA scan is the definitive study for diagnosis. Early suspicion avoids the delay in the diagnois, thereby further reduced the cost of un necessary investigations and discomfort for the patients .This condition is more frequently seen in female patients, and does not seem to be related to obesity. Most patients’ symptoms are relieved by laparoscopic cholecystectomy.
Program Number: P391