Acalculous biliary tract disorders: the value of fatty meal-cholescintigraphy.
BACKGROUND
The management of patients with symptoms consistent with biliary tract disease but without evidence of cholelithiasis is difficult. This study was undertaken to test the value of cholescintigraphy in predicting the success of cholecystectomy in patients with acalculous biliary tract disorders.


METHODS
A prospective study was carried out on 73 patients presenting with recurrent upper quadrant pain without documented evidence of gallstones on ultrasound. Fatty meal-cholescintigraphy was performed on all patients and the gallbladder ejection fraction was calculated. Laparoscopic cholecystectomy was performed in patients with ejection fractions of <40%, followed by histopathological analysis and assessment of symptomatic improvement.


RESULTS
There were 43 men and 30 women with a mean age of 33.4 years. Forty-one patients had abnormal ejection fractions. All except one patient had a laparoscopic cholecystectomy. The pathological diagnosis of chronic cholecystitis was made in 33 patients and acute on chronic cholecystitis documented in four patients. Five patients had cholesterolosis and two of these had associated chronic cholecystitis. All except three patients had complete relief of symptoms post-operatively with a mean follow-up of 10 months.


CONCLUSIONS
Modified cholescintigraphy is a useful test for predicting which patients with acalculous biliary tract disease benefit from a cholecystectomy.
Gunna
B R
BR
Department of Surgical Gastroenterology, Apollo Hospital, Jubilee Hills, Hyderabad, India 500033. gunnabr@hd1.vsnl.net.in
Yannam
G R
GR
Kavita
N
N
Pathak
S
S
Alla
B R
BR
D000328:Adult; D000368:Aged; D000814:Aniline Compounds; D001660:Biliary Tract Diseases / Q000175:diagnosis* / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D005998:Glycine; D006801:Humans; D007098:Imino Acids; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D011446:Prospective Studies; D019275:Radiopharmaceuticals
D000814:Aniline Compounds; D007098:Imino Acids; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C034837:technetium Tc 99m mebrofenin; D005998:Glycine