Stimulation with Fatty Meal (Lipomul) to Assess Gallbladder Emptying in Children with Chronic Acalculous Cholecystitis
作者:
Colleen Hadigan,
Steven Fishman,
Leonard Connolly,
S. Treves,
Samuel Nurko,
期刊:
Journal of Pediatric Gastroenterology and Nutrition
(OVID Available online 2003)
卷期:
Volume 37,
issue 2
页码: 178-182
ISSN:0277-2116
年代: 2003
出版商: OVID
关键词: Lipomul;Gallbladder ejection fraction;Acalculous cholecystitis
数据来源: OVID
摘要:
ObjectiveChronic acalculous cholecystitis previously has been diagnosed by hepatobiliary scan stimulated with intravenous octapeptide of cholecystokinin. This compound may soon be unavailable in the United States. The goal of this study was to describe the characteristics of children with chronic acalculous cholecystitis diagnosed by hepatobiliary scintigraphy with oral Lipomul challenge, and to evaluate their clinical response to cholecystectomy.MethodsRetrospective chart review of patients with no gall stones detected by abdominal ultrasound or computed tomography with gallbladder ejection fraction (GBEF) <35% after Lipomul challenge who subsequently underwent cholecystectomy. Fifteen patients with a mean age of 14.9 ± 0.9 years were included. The mean duration of symptoms before evaluation was 8.2 ± 2.5 months.ResultsThe mean GBEF after Lipomul challenge was 16.7% ± 2.7%. All patients had abdominal pain. Ninety percent had right upper quadrant pain and 86% had typical biliary colic. Pain was precipitated by fatty meals in 73.3%. Histopathologic analysis of the gallbladder demonstrated chronic cholecystitis in 80% of cases. The mean postoperative follow-up was 20 ± 5 months. Six months after the surgery, nine patients (60%) were asymptomatic, five (33%) had marked improvement of symptoms, and one (6%) was unchanged. At the time of latest follow-up, symptoms had reappeared in two patients who had been asymptomatic at the 6-month visit (13%). Seven patients (46%) remained asymptomatic, five (33%) had marked improvement but continued to have some persistent symptoms, and one (6%) was unchanged.ConclusionsChronic acalculous cholecystitis may be responsible for right upper quadrant pain in children without gallstones. A GBEF <35% at 30 minutes after Lipomul challenge may be useful in identifying patients who could benefit from cholecystectomy. Lipomul may be a good alternative to cholecystokinin for gallbladder stimulation during scintigraphy.
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