Laparoscopic cholecystectomy

[vonts]

I'm 36 and very active, but I've had left upper quadrant pain for  >6mos.  I had an abdominal scan which showed Gallbladder Sludge and then was refferred to a surgeon.  

I went to a gastro specialist before the surgeon who sent me for a HIDA scan which showed an ejection rate of 7%.  I also had an upper endoscopy which showed no abnormalities with the exception of some food still left in my stomach.  

I then had a solid and liquid gastric emptying study which showed delayed emptying.  I consulted with a surgeon and am scheduled for a cholecystectomy.  The surgeon I consulted with informed me that sometimes the GallBladder can cause slowed emptying of the stomach and in any case since I have two positive tests for gallbladder disease and am asymtomatic with minor nasuea and some upper right quadrant pain on occassion, (<1mo)the removal could quite possibly clear everything up.

My Gastro also prescribed Reglan, but I'll modify my diet and try just about anything before taking it as it appears to have some pretty serious side affects and the pain in the left upper abdominal region is aggravated by large meals, fatty meals, etc.  It appears that diet does seems to alleviate some of the symtoms.

Given the tests and symtoms would a cholecystectomy be a worthwhile procedure?

[Kevin Pho, MD]

There are studies that show that those with a low gallbladder ejection fraction would be helped by surgery.  The fact that some of the symptoms were reproduced during the HIDA scan with CCK stimulation suggests that removing the gallbladder would help.  

Another consideration would be to obtain an upper endoscopy - this is the most comprehensive test to evaluate the upper digestive tract, which certainly also could be the cause of your symptoms.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[surgeon]

you are in a grey-zone catgegory: the tests of your gallbladder are not entirely normal, but neither are they proof of something significant. A low ejection fraction by itself is hard to evaluate; if when the stuff was injected to cause the gallbladder to empty your symptoms were reproduced, that's a bit more suggestive. As it is, neither your symptoms nor your tests are proof positive that your gallbladder is the problem. Having it removed may or may not help. What does the gastroenterologist think?

[vonts]

Actually after the scan I did experience some discomfort in the right upper abdominal region. No extreme pain, but discomfort and also I've experience an intense sharp pain at night on occassion that has awoken me.  The gastro physcian referred me to the surgeon and suggested it be removed.

[surgeon]

the additional info is important: the fact that the scan caused discomfort, and that you get sharp pains that awaken at night, which is typical of gallbladder pain suggest that the surgery is more likely than not to help.

[vonts]

For everyone who wants to know here is a great study on GallBladder Removal for acalculous gallbladder disease; ie, without stones.
http://www.baylorhealth.edu/proceedings/13_4/13_4_fuller.html

[surgeon]

The important point about the study referred to is that it does not say how people were identified as having acalculous disease; in other words, it studied people already identified in some way as having the disease, and then tested with HIDA scan to determine if that was a way of predicting outcome. The more pertanent issue is whether HIDA scan is predictive of outcome in people who have not otherwise been identified as having disease. It's an important distinction. Because there are other ways to diagnose acalculous disease; for example, an ultrasound or CT scan may identify thickening of the wall of the gallbladder. In such a case, there's really no reason to do a HIDA scan, because disease has been proven. The point of the article was, basically, to say that laparascopic surgery was an effective way to treat acalculous disease; this is not big news. If the gallbladder is diseased, it stands to reason that removing it will help most people. The questions is, if every test of the gallbladder is normal except a HIDA scan, what is the chance that removing the gallbladder will help? The study referred to does not answer that one.

[vonts]

My original post shows I have two positive tests along with symtoms and was not trying to utilize the article to prove that a single HIDA scan is grounds for removal, the questions I posed originally references having symtoms for GallBladder Disease as well as two tests Abdominal ultrasound and HIDA scan along with symtoms.  Please re-read my original post.

Here's what I said:

I had an abdominal scan which showed Gallbladder Sludge and then was refferred to a surgeon.

HIDA scan which showed an ejection rate of 7%.

I have two positive tests for gallbladder disease and am asymtomatic with minor nasuea and some upper right quadrant pain on occassion, (<1mo)

[claraherb]

A related discussion, abdominal PAIN was started.