K. Skipper et al., Laparoscopic cholecystectomy for an abnormal hepato-iminodiacetic acid scan: A worthwhile procedure, AM SURG, 66(1), 2000, pp. 30-32
Patients with symptoms similar to symptomatic cholelithiasis but with no so
nographic evidence of gallstones can be difficult to manage. Cholecystokini
n (CCK)-stimulated hepatobiliary scans can be helpful in determining whethe
r the biliary tract is the potential source of the symptoms, We retrospecti
vely reviewed the medical records of 69 patients at our institution who und
erwent CCK-stimulated hepatobiliary scans over a 2-year period. Twenty-nine
of 69 patients had an abnormal gallbladder ejection fraction (defined as 3
5% or less). All 29 patients had no sonographic evidence of cholelithiasis.
Seventeen of the 29 underwent cholecystectomy. There were no complications
or deaths within the operative group. Fifteen of the pathologic specimens
had evidence of chronic cholecystitis, one was cytomegalovirus cholecystiti
s, and one showed only cholesterolosis, There was no other intraperitoneal
pathology to explain the abdominal symptoms. At an average follow-up of II
months, eight patients (47%) in the operative group had complete resolution
of their symptoms, six (35%) had significant improvement, two (12%) were u
nchanged, and one (6%) was worse. Twelve of 29 patients did not have a chol
ecystectomy, At an average follow-up of II months, four (33%) of these pati
ents had improvement and eight (66%) reported no change or worsening of the
ir symptoms. In the operative group, 53 per cent had reproduction of their
symptoms with CCK stimulation, and in the nonoperative group, 33 per cent r
eported symptoms. Average gallbladder ejection fraction was 10 per cent (ra
nge, 0-32) in the operative group and 23 per cent (range, 0-35) in the nono
perative group. Liver function tests were similar in each group, CCK-stimul
ated hepatobiliary scans were helpful in defining biliary tract disease in
patients without gallstones. These patients may benefit from cholecystectom
y with minimal risk of morbidity and mortality.