CASE REPORT   

Chirurgia 2004 April;17(2):55-8

Copyright © 2004 EDIZIONI MINERVA MEDICA

language: English

A case report of biliary dyskinesia and review of the literature

Kiriakopoulos A., Tsakayannis D., Polychronopoulos G., Linos D.

Biliary tract motility disorders represent functional disturbances of bile outflow that may occasionally give rise to symptoms of biliary colic and require demanding diagnostic and therapeutic approach. Anatomically, this clinical entity may be associated with motility disorder of the gallbladder or dysfunction of the sphincter of Oddi. Patients typically present with biliary colic without objective evidence of gallstones and diagnosis requires a decreased gallbladder ejection fraction revealed by radionuclide investigation in cases of gallbladder dyskinesia or manometric disturbances in cases of sphincter of Oddi dysfunction. Laparoscopic cholecystectomy represents a valid treatment option in the former, whereas division of the sphincter of Oddi is needed for the latter. However, exclusion of other causes of pain and specific laboratory diagnosis with scintigraphy or manometric tests are mandatory, otherwise incomplete symptom resolution is not uncommon. In the present case, a 49-year-old female patient was hospitalised for recurrent biliary colic in the absence of gallstone disease. Biliary scintigraphy with CKK-99mTc-bromo-iminodiacetic acid (CCK-BRIDA-scan) revealed gallbladder-emptying dysfunction indicative of biliary dyskinesia. The patient underwent laparoscopic cholecystectomy, recovered uneventfully and remains symptom free, 1 year after the operation. In conclusion, biliary dyskinesia should be considered early in the diagnostic process of biliary colic in the absence of gallstone disease. In our case, laparoscopic cholecystectomy after secure scintigraphic confirmation of the disease was associated with excellent results and maximum patient satisfaction.