Biliary hyperkinesia: A potentially surgically correctable disorder in adolescents

Biliary colic, which is characterized by intermittent, usually postprandial, right upper quadrant pain, is a common complaint in the pediatric population and usually prompts further evaluation with an abdominal ultrasound. Those patients without evidence of cholelithiasis are sometimes referred for a hepatobiliary iminodiacetic acid scan with cholecystokinin stimulation (CCK-HIDA) to assess gallbladder function. When the gallbladder empties poorly, the diagnosis of biliary dyskinesia, defined as a gallbladder ejection fraction less than 35%, is made, and cholecystectomy can be considered. There is a subset of symptomatic patients, however, who have an abnormally high ejection fraction, defined as greater than 65%. The approach to the treatment of these patients with biliary hyperkinesia is still undetermined, as there is little in the literature regarding this entity. With IRB approval (protocol #1307002185), we report our series of three adolescent females found to have biliary hyperkinesia whose symptoms immediately resolved following laparoscopic cholecystectomy.