PAIN PATTERNS AFTER DISTENSION OF THE GALLBLADDER IN PATIENTS WITH ACUTE CHOLECYSTITIS

Background: Visceral pain is characterized by poor pain localization a nd a referred or radiating pain pattern. Its clinical importance in th e abdomen is stressed by the finding that about one-third of patients still complain of abdominal pain after cholecystectomy. A better under standing of symptoms arising from the gallbladder and the underlying p athophysiology is therefore desirable. The aim of the present study wa s consequently primarily to characterize the symptom patterns after di stension of the gallbladder. Secondary aims were to describe the press ure-volume relation in the gallbladder and the cystic duct opening pre ssure. Methods: Twelve patients (nine women, three men) treated with c holecystostomy for acute cholecystitis were investigated. Simultaneous cholescintigraphy and measurement of changes in intraluminal gallblad der pressure after injections of saline through a gallbladder catheter were performed. After each injection of saline the localization of pa in and the presence of nausea and vomiting were registered. The inject ions continued until the patient felt abdominal pain necessitating ces sation of the investigation or until the cystic duct opened (visualize d on cholescintigraphy). Results: Distension of the gallbladder caused pain in 10 of the 12 patients. In 70% the pain was localized under th e right costal margin or in the epigastrium. No mathematical formula c ould describe the pressure-volume relation in the gallbladder. The cys tic duct opening pressure varied between 3 and 44 mmHg. Conclusions: P ain caused by increased gallbladder pressure is localized mostly, but not always, under the right curvature and in the epigastrium. A substa ntial variation in cystic duct opening pressure was found.