Association Between Bariatric Surgery and Gallbladder Hyperkinesis: A Case Report and Review of Management Strategies

Author(s):
Ulochi Nwagwu; Shaniah Holder; Muhammed Zain Ali; Farhana Ghouse; Frederick Tiesenga

Background:

In treating severe obesity, bariatric surgery has been beneficial in improving or resolving metabolic comorbidities such as type II diabetes mellitus, and increasing life expectancy. Although bariatric surgery affects the stomach and intestines, it is also inadvertently affects the gallbladder. The incidence of gallbladder disease post bariatric surgery is maximal during the period of rapid weight loss. With the most common complications being the formation of gallstones due to rapid weight loss involving cholesterol supersaturation of bile and gallbladder hypomotility secondary to decreased cholecystokinin secretion related to the hypocaloric diet. Gallbladder hypomotility, biliary dyskinesia, is a common gallbladder functional disorder defined by an ejection fraction (EF) of less than 35% on cholecystokinin HIDA scan. It is standard to perform a cholecystectomy in the management of this condition with effective results. However, there is a paucity in research and management of patients with biliary colic symptoms and high gallbladder ejection fraction post bariatric surgery. This case study highlights the associations between bariatric surgery and the development of gallbladder hyperkinesis in the early post-operative period as well as the management strategy.

Hypothesis:

The use of laparoscopic cholecystectomy on post bariatric patients with biliary colic symptoms and high gallbladder ejection fraction will provide symptomatic relief and complete resolution.

Methods:

We present a case of a thirty seven year old female with a past medical history of morbid obesity (BMI 47 kg/m2) presented to the emergency department with nausea, vomiting, right upper quadrant pain, constipation, and anorexia. One month prior to her presentation, she underwent a laparoscopic sleeve gastrectomy. She stated she had been unable to tolerate most liquids and foods since her procedure. After extensive workup for her pain, the patient underwent a laparoscopic cholecystectomy as a management technique currently utilized for hypokinetic gallbladder and gallstones.

Results:

The patient’s initial workup was essentially normal except for the cholecystokinin 99m technetium-labeled hepatoiminodiacetic acid (CCK-HIDA) scan finding of gallbladder ejection fraction of 87%.Patient endorsed complete resolution of symptoms after receiving a laparoscopic cholecystectomy.

Conclusions:

A rare occurrence, the hyperkinetic gallbladder, can cause debilitating abdominal pain, nausea, and anorexia. Our patient had an excellent response to cholecystectomy. It is concluded that patients with biliary colic and gallbladder EF of 80% or higher should be strongly considered for cholecystectomy.