Gallbladder Dyskinesia in Children

BACKGROUND AND OBJECTIVES The purpose of this study was to describe clinico-pathological characteristics in a group of children with motility disorders of the gallbladder and correlate the findings with cases receiving surgical treatment for gallstone during the same period. METHODS Retrospective chart analysis of all cholecystectomies from January, 1990 to June, 1995. Analysis of demographics, symptoms and duration, associated illnesses, diagnostic studies, pathological stratification, length of stay, complications, follow-up and patient satisfaction. Statistical comparison of clinical variables between gallstone and dyskinesia patients was analyzed using chi-square, and analysis of variance (ANOVA). RESULTS Twelve children (14%) of 85 underwent laparoscopic cholecystectomy during a 66-month period for gallbladder dyskinesia. Their mean age was 14 +/- 3 years (range 7 to 18). Ten patients were female and two were males for a 5:1 ratio. Classic biliary symptoms (RUQ abdominal pain and FFI) predominated for a mean of 48 weeks. A predisposing factor was previous family history of gallstones in five cases (42%). The diagnosis was obtained after gallbladder non-visualization in one child and low ejection fractions after CCK stimulated hepatobiliary scan studies in the remainder. Mean ejection fraction was 16.8%. Ten cases (83%) had mild to moderate chronic cholecystitis, and two children had unremarkable pathologic changes. These changes correlated with the mean duration of symptoms, not with ejection fraction volumes. After a mean follow-up of 17 months, 11 children are free of symptoms, and one continues with intermittent diarrhea. Comparison between calculous and dyskinesia patients showed that biliary dyskinesia children suffer more dyspepsia, undergo more diagnostic studies and have a significant family history of gallstones. CONCLUSIONS Gallbladder dyskinesia (GD) is a motility disorder causing symptoms similar to those of gallstones, although the clinical picture is more protracted. Diagnosis is confirmed using CCK stimulated hepatobiliary scan ejection fractions after thorough diagnostic work-up for other gastrointestinal causes. Laparoscopic cholecystectomy is the treatment of choice. Most children present with mild to moderate changes of chronic cholecystitis depending on duration of symptoms. Clinical improvement is seen in most cases after surgery.