Is persistent opacification of the gall bladder on cholecystography an indication for cholecystectomy?

THERE is a widespread reluctance amongst surgeons to undertake cholecystectomy on the basis of symptoms alone. These views derive from early studies suggesting an unacceptable incidence of the post-cholecystectomy syndrome in such cases.' There is however, a well recognised group of patients with typical biliary tract symptoms and normal oral cholecystography ('stoneless symptoms') who pose considerable management problems. It has been suggested that the persistence of contrast medium in the gall bladder on a straight x-ray taken 24 hours after an otherwise normal cholecystogram is a reliable index of gall bladder dysfunction.2 Whilst more sophisticated techniques of demonstrating gall bladder function exist these are not universally available, outside specialist centres. The concept, that the simple, inexpensive, addition of one further x-ray, 24 hours after normal oral cholecystography might help to select out those with genuine gall bladder pathology, has considerable clinical appeal. The reliability of persistant opacification of the gall bladder in discriminating gall bladder pathology in the absence of calculi, has been assessed in a small series of patients.