Annual Meeting of the North American Society for Pediatric Gastroenterology and Nutrition; Orlando, October 22-24, 1998
Non-calculous biliary tract pain is a common cause of morbidity in adults, yet has not been well studied in children. We have reviewed our experience with biliary dyskinesia over the last two years. Thirty-nine children with chronic and recurrent epigastric or right upper quadrant pain, were sent for cholescintigraphy followed by an injection of cholecystokinin octapeptide (CCK). The % of emptying of the gallbladder was calculated (Normal >35%). Ultrasound examination of the gallbladder showed no evidence of cholelithiasis and previous diagnostic evaluations (EGD, H.pylori test, serum chemistries) were negative. Fourteen children with symptoms suggestive of gallbladder disease, i.e., chronic and recurrent epigastric and/or RUQ pain, usually accompanied by nausea and exacerbated by ingestion of fatty foods, and with gallbladder ejection fractions of less than or equal to 35%, underwent laparoscopic cholecystectomy. In 9 of the 14, pericholecystic adhesions were visualized. The majority of the gallbladders removed were pathologically normal. In all 14 patients, the chronic pain was immediately relieved, and the children remained asymptomatic during follow-up of 4-20 mo. Chronic biliary pain may be more frequent in children than previously recognized.