Fatty meal ultrasonography in chronic acalculous cholecystitis

Chronic acalculous cholecystits typically presents with biliary symptoms, normal blood tests and unremarkable ultrasound, computerized tomography and magnetic resonance cholangio-pancreatography. However, cholescintigraphy may show reduced gallbladder ejection fraction (GBEF). There are no reports on using ultrasound to measure GBEF in adults. Twenty-eight patients with the above presentation underwent ultrasound before and after ingestion of a standardized fatty meal. Consequently, GBEF was calculated. Seven patients had reduced GBEFs (<38%). Two of these patients underwent cholecystectomy and both were found to have chronic gallbladder inflammation. Three patients with normal GBEFs underwent cholecystectomy and were also found to have chronic gallbladder inflammation. There may be a role for fatty meal ultrasonography in the diagnosis of chronic acalculous cholecystitis, but it should be used more widely in this patient cohort for its role to be established. It ideally needs to performed alongside cholescintigraphy for the comparison of accuracy.