 |
Case Report
Biliary dyskinesia an undiagnosed cause of abdominal pain: Case report
1 Postgraduate Medical Doctor, PGY4 General Surgery, General Enrique Garcés Hospital, Quito, Ecuador
2 Postgraduate Doctor, PGY4 General Surgery, Metropolitan Hospital, Quito, Ecuador
3 Postgraduate Doctor, PGY4 General Surgery, General Hospital Enrique Garcés, Quito, Ecuador
4 Resident Doctor, General Surgery, General Hospital Macas, Macas, Ecuador
Address correspondence to:
Jhony A Delgado
Passage OE9B S12-26 and Los Canelos, Chilibulo, Quito,
Ecuador
Message to Corresponding Author
Article ID: 100005G02VM2020
Access full text article on other devices
Access PDF of article on other devices
How to cite this article
Medina VR, Delgado JA, Valencia AS, DÃaz DA, Ordoñez SR, Palacios PA. Biliary dyskinesia an undiagnosed cause of abdominal pain: Case report. Edorium J Gastrointest Surg 2020;5:100005G02VM2020.ABSTRACT
Introduction: Biliary dyskinesia is a functional gallbladder disorder of rare presentation, the diagnostic suspicion is very important, the standard confirmatory test is a hepatobiliary iminodiacetic acid (HIDA) scan (scintigraphy) and standard treatment is cholecystectomy.
Case Report: A 37-year-old female who had a surgical record of appendectomy, two caesarean sections, salpingoclasm, and cystectomy for ovarian cyst presented a 48-hour episodic postprandial abdominal pain that reached 10/10 intensity on visual analogue scale (VAS) scale. The pain was located in the right hypochondrium and dorsal region, it was accompanied by nausea. On physical examination, patient presented positive Murphy’s sign. Furthermore, laboratory tests showed no leukocytosis nor neutrophilia. In addition, pancreatic enzymes, kidney, and liver function ranged within normal. Gallbladder presented normal volume as measured by ultrasound. In addition, thin walls without endoluminal lesions were found, intra- and extrahepatic bile ducts without dilation were detected. Due to the persistence of pain and the lack of association with lithiasis etiology, a HIDA scan was performed, which reported normal filling of the gallbladder, with a 27.22% ejection fraction, whereby a diagnosis of biliary dyskinesia was determined.
Conclusion: Laparoscopic cholecystectomy was performed, finding a gallbladder with signs of inflammation according to the pathology report. Afterward, the patient was discharged without complications. The diagnosis is made by exclusion of other pathologies and it is confirmed by a HIDA scan. Cholecystectomy is proven to be the treatment of choice, also aiding the diagnosis of biliary dyskinesia with relief of symptoms in most patients.
Keywords: Biliary dyskinesia, Ejection fraction, HIDA (hepatobiliary iminodiacetic acid), Laparoscopic cholecystectomy
SUPPORTING INFORMATION
Author Contributions
Victor R Medina - Substantial contributions to conception and design, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Jhony A Delgado - Substantial contributions to conception and design, Analysis of data, Drafting the article, Final approval of the version to be published
Alexandra S Valencia - Substantial contributions to conception and design, Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Diego A DÃaz - Drafting the article, Final approval of the version to be published
Stalin R Ordoñez - Substantial contributions to conception and design, Interpretation of data, Drafting the article, Final approval of the version to be published
Paola A Palacios - Substantial contributions to conception and design, Analysis of data, Drafting the article, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2020 Victor R Medina et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
