Biliary hyperkinesia, a new diagnosis or misunderstood pathophysiology of dyskinesia: A case report. (2019)

• Record Type: Journal Article
• Authors: Bates, John A.; Dinnan, Kelly; Sharp, Victoria
• Is Part Of: International journal of surgery case reports. Volume 55(2019)
• Page Start: 80
• Page End: 83
• Publication Date: 2019
• Subjects: Biliary hyperkinesia -- Normokinetic biliary dyskinesia -- Biliary dyskinesia -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2019.01.011
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Bilairy hyperkinesia or normokinetic biliary dyskinesia may have no "pathological" findings of disease or dysfunction. The majority of patients, both adult and pediatric, have symptoms improved/resolved following laparoscopic cholecystectomy. Multiple case series have been performed, and no conclusive pathophysiological abnormality has been observed. The literature would benefit from a larger prospective study. Abstract: Introduction: Biliary colic, characterized by intermittent right upper quadrant abdominal pain is a common complaint in the United States population. Patients whose pain is undiagnosed by ultrasound generally undergo hepatobiliary iminodiacetic acid scan with cholecystokinin stimulation (HIDA-CCK) to assess function of the gallbladder and biliary tree. Traditionally, two outcomes are possible based on a measured ejection fraction of the gallbladder: either dyskinesia or normal function is diagnosed. Biliary dyskinesia, or hypokinesia of the gallbladder, is accepted as an ejection fraction less than 35%, while an accepted normal functioning gallbladder ejection fraction is greater than 35%. Case: We report a case of a fifteen-year-old female who had functional gallbladder disease per Rome IV criteria due to intermittent biliary colic, with exception to the ejection fraction measurement which was elevated at 96.5%. She underwent laparoscopic cholecystectomy with complete symptom resolution. Discussion: As demonstrated in the literature reviewed here, these subsets of patients, who present with normal to high ejection fractions, have undergone laparoscopic cholecystectomy with resolution of pain in several case studies. Conclusion: Many unknown variables still exist due to lack of prospective studies, most notably the pathophysiology and definitive indications for surgical treatment. As such, we propose that surgical options should not be limited to those who display the traditional findings of biliary dyskinesia, but also patients who demonstrate typical symptoms with normal to elevated ejection fraction, following work up to rule out the extensive differential diagnoses for right upper quadrant abdominal pain.