90 percent of symptomatic patients undergoing
cholecystectomy have
cholelithiasis with 10% categorized as asymptomatic
cholecystitis. In both instances, the gallbladder is evident on ultrasonography. In children with symptomatic biliary
dyspepsia, the decision to proceed to
cholecystectomy is made difficult if choleliths are not seen on ultrasonography. This decision is made even more difficult if the gallbladder itself is not seen on repeated imaging. In a cohort of 54
cholecystectomies, 3 cases, with recurrent right upper quadrant
pain and undetectable gallbladders on repeat ultrasonography, were identified. After prolonged observation all underwent successful
cholecystectomy. Histology demonstrated a markedly fibrotic and thickened gallbladder in all. Given this experience, we suggest that nonvisibility of the gallbladder, in fact, maybe be a feature of a chronic
acalculous cholecystitis. We advise consideration of
cholecystectomy for chronic biliary
dyspepsia where repeat ultrasonography fails to demonstrate a gallbladder.