title: Stimulation with fatty meal (Lipomul) to assess gallbladder emptying in children with chronic acalculous cholecystitis.
abstract: OBJECTIVE
  Chronic 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.
  
  
  METHODS
  Retrospective 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.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  Chronic 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.
authors.affiliation: Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Colleen
authors.initials: C
authors.lastname: Hadigan
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Fishman
authors.forename: Leonard P
authors.initials: LP
authors.lastname: Connolly
authors.forename: S Ted
authors.initials: ST
authors.lastname: Treves
authors.forename: Samuel
authors.initials: S
authors.lastname: Nurko
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology; D042101:Acalculous Cholecystitis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D002648:Child; D002763:Cholecystectomy; D002908:Chronic Disease; D003314:Corn Oil / Q000494:pharmacology; D005260:Female; D005500:Follow-Up Studies; D005704:Gallbladder / Q000000981:diagnostic imaging; D016473:Gallbladder Emptying / Q000187:drug effects*; D006801:Humans; D008297:Male; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D003314:Corn Oil