Role of Cholecystectomy in Symptomatic Hyperkinetic Gallbladder Patients.

INTRODUCTION: Biliary dyskinesia is defined by a gallbladder ejection fraction (EF) of less than 35% on HIDA scan, and these patients have shown a good response to cholecystectomy. Management of patients with biliary colic symptoms who have a hyperkinetic gallbladder (EF > 80%) is not clearly defined. Herein, I report three cases of the symptomatic hyperkinetic gallbladder that were successfully managed with cholecystectomy. Case Report. Patient 1was a 56-year-old female presented with pain in the right upper abdomen for one month. Her workup was unremarkable except for the gallbladder EF of 86%. Patient 2 was a 33-year-old female with similar symptoms and workup with gallbladder EF of 97%. Patient 3 was a 20-year-old female with right upper abdominal pain and gallbladder EF of 91%. Patients 1 and 3 had the normal US, normal CT scan, and normal EGD. Patient 2 had normal US and CT but did not undergo EGD. All three patients underwent laparoscopic cholecystectomy and had complete resolution of their symptoms. CONCLUSION: The hyperkinetic gallbladder is a rare phenomenon, which can cause debilitating right upper quadrant pain. All three patients had an excellent response to cholecystectomy. Therefore, it is concluded that the patients with biliary colic and gallbladder EF of 80% or higher should be strongly considered for surgery.

Duplication of the Gallbladder as an Operative Surprise: A Case Report with Review of the Literature.

INTRODUCTION: Duplication of the gallbladder is a rare congenital anomaly of the biliary system. Anomalous anatomy of the biliary system is associated with an increased risk of complications such as bile duct injury during cholecystectomy. Herein, I present a case report of duplication of the gallbladder, which was an operative surprise as the patient's preoperative workup did not reveal any evidence of duplication of the gallbladder. Case Report. A 60-year-old female was admitted for management of recurrent pancreatitis. Diagnosis of biliary pancreatitis was made as her CT and US revealed cholelithiasis. During laparoscopic cholecystectomy, she was found to have duplication of the gallbladder, which was a surgical surprise. Both the gallbladders were successfully removed, and the patient had an uneventful postoperative course. CONCLUSION: Duplication of the gallbladder is a rare congenital anomaly, which could be associated with other congenital anomalies of the bile duct and vascular system. Extreme care should be taken during cholecystectomy as these anomalies could lead to serious injury to the bile duct and vessels.

Gastric duplication cyst: two case reports and review of the literature.

Background. Duplication of the alimentary tract is a rare congenital anomaly. Gastric duplication cysts (GDCs) represent 4% of all alimentary tract duplications, and approximately 67% manifest within the first year of life. Duplication cysts in adults are generally encountered as incidental findings at endoscopy or laparotomy. Herein, we report two rare cases of symptomatic GDC presenting in adults. Case 1. A 27-year-old male presented with a five-month history of back pain. Exam revealed mild epigastric tenderness with a vague palpable mass in left upper abdomen. CT scan showed 8 × 7.4 × 6 cm homogenous, nonseptated cystic mass posterosuperior to pancreatic tail. On laparotomy, a cystic mass measuring 11 × 8 cm was found, which was densely adherent to posterior wall of stomach suggestive of GDC. Case 2. A 28-year-old woman presented with epigastric pain associated with vomiting for 2 months. Exam revealed mild epigastric tenderness. CT scan showed four cystic lesions in the medial wall of distal stomach measuring approximately one cm each suggestive of duplication cysts. Exploratory laparotomy with antrectomy and truncal vagotomy with Billroth II reconstruction were performed. Pathology in both patients was diagnostic of GDC. Conclusion. GDC is a rare anomaly, and its presentation in adults is even rarer.