Severe Gallbladder Dyskinesia With 2% Ejection Fraction: A Comprehensive Clinicoradiologic and Pathologic Case Correlation

TL;DR

This case study describes a patient with severe gallbladder dysfunction diagnosed through imaging and successfully treated with surgery.

Contribution

The case demonstrates the importance of functional imaging in diagnosing gallbladder issues without structural abnormalities.

Findings

A 2% gallbladder ejection fraction was observed, indicating severe contractile dysfunction.

Symptoms resolved after laparoscopic cholecystectomy despite mild histopathological findings.

Functional imaging proved critical in diagnosing biliary dysmotility in the absence of gallstones.

Abstract

Gallbladder dyskinesia (GBD) is a functional biliary disorder characterized by biliary colic in the absence of cholelithiasis or mechanical obstruction and is identified by reduced gallbladder ejection fraction (EF) on cholecystokinin (CCK)-stimulated hepatobiliary scintigraphy. Patients may experience significant symptoms due to impaired gallbladder contractility and bile stasis despite the absence of gallstones or inflammatory structural abnormalities on imaging.

We present a 42-year-old male with a three-month history of episodic right upper quadrant (RUQ) pain triggered by fatty meals. Abdominal ultrasound demonstrated no cholelithiasis, sludge, wall thickening, or pericholecystic fluid. Contrast-enhanced computed tomography (CT) revealed a distended gallbladder without obstructing gallstones or inflammatory changes. CCK-hepatobiliary iminodiacetic acid (HIDA) scintigraphy demonstrated a markedly reduced gallbladder EF of 2%, consistent with severe contractile dysfunction. The patient underwent an uncomplicated laparoscopic cholecystectomy. Histopathology revealed mild chronic cholecystitis and cholesterolosis. At follow-up, he reported complete resolution of symptoms and tolerance of a normal diet.

This case highlights the diagnostic value of functional biliary imaging in symptomatic patients without gallstones or inflammatory structural abnormalities. Profound reduction in gallbladder EF may correlate with severe biliary dysmotility and favorable postoperative outcomes.

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