Segmentation of the gallbladder: Effect on bile entry and exit and its clinical relevance in a patient with abdominal pain

Krishnamurthy, Gerbail T.; Krishnamurthy, Shakuntala; Milleson, Thomas; Brown, Paul H.; Urstadt, Donna S.

doi:10.1097/mnm.0b013e328013eb2f

Cited by 13 publications

(6 citation statements)

References 10 publications

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“…In our case, the ultrasound examination was sufficient to make the diagnosis given the uncomplicated nature of the pathology. 5 In our case, ultrasound confirms the diagnosis by showing septation in the gallbladder.…”

Section: Discussionsupporting

confidence: 77%

Gallbladder diaphragm: about a case

et al. 2021

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Diaphragm gallbladder is a very rare anomaly of gallbladder embryogenesis. This malformation is very rare in adults and represents 0.1% of gallbladder anomalies. It can remain asymptomatic for a long time and be discovered fortuitously during a radiological examination for another pathology or be revealed by chronic abdominal pain or by a complication such as cholecystitis or biliary peritonitis. We report the observation of a 34 years old woman with chronic hepatic colic. The biological work-up including a blood count, a hepatic cytolysis and cholestas and CRP determination did not reveal any abnormality, whose morphological examinations concluded to an uncomplicated diaphragm gallbladder. A laparoscopic cholecystectomy was performed. The post-operative course was unremarkable. The intraoperative finding by opening the cholecystectomy specimen confirmed the diagnosis of a diaphragm gallbladder. Histological study confirms the diagnosis of diaphragm vesicle cholecystitis. In this document, we described the clinical and radiological characteristics of this rare anomaly.

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Section: Discussionsupporting

confidence: 77%

Gallbladder diaphragm: about a case

et al. 2021

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“…Curvilinear folds of the gallbladder body or neck were commonly observed in patients but were present in only one control subject. Folds of the gallbladder body resulting in "Phrygian caps" have been recognized for many years [17], and segmentation of the gallbladder by a fold or septum has been reported to decrease scintigraphic gallbladder emptying [18]. In our study, asymmetric patterns of gallbladder contraction also occurred somewhat more often in patients than control subjects.…”

Section: Discussionsupporting

confidence: 53%

Prospective Assessment of Dynamic CT and MR Cholangiography in Functional Biliary Pain

Fidler

Knudsen

Collins

et al. 2013

American Journal of Roentgenology

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Dynamic CT cholangiography and MR cholangiography performed during pharmacologic stimulation accurately measure gallbladder EFs and detect missed gallstones. Gallbladder shape before and during contraction differs between patients with functional biliary pain and healthy control subjects. Dynamic CT cholangiography and MR cholangiography are promising techniques that might improve selection of patients to undergo cholecystectomy for functional biliary pain.

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“…The GBEF as evaluated in this study did not differ between patients with segmented or non-segmented GB. In a previous study, the GBEF measured in segmented GB was lower than that in non-segmented GB[ 14 ]. In this study, we observed the appearance of partial filling and emptying events in each lumen in segmented GB using HBS imaging.…”

Section: Discussionmentioning

confidence: 93%

“…This term is not commonly used; however, GB segmentation without adenomyomatosis is often observed in imaging studies of patients of any age. Krishnamurthy et al [ 14 ] reported that microscopic examination of a segmented GB revealed chronic inflammatory changes, fibrosis, and wall thickening[ 14 ]. The strictures caused by the annular thickening of the GB wall may be narrow[ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Classification of hepatobiliary scintigraphy patterns in segmented gallbladder according to anatomical discordance

Lee¹,

Jung²,

Lee³

et al. 2023

World J Clin Cases

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BACKGROUND Hepatobiliary scintigraphy (HBS) is a useful diagnostic imaging technique that uses radiotracers to evaluate the function of the gallbladder (GB) and biliary system. In segmented GB, s ome HBS images reveal a discordant GB boundary as compared to anatomical images. AIM To evaluate the characteristics of HBS in segmented GB and determine the clinical relevance according to HBS characteristics. METHODS A total of 268 patients with chronic cholecystitis, gallstones, or biliary colic symptoms who underwent HBS between 2011 and 2020 were enrolled. Segmented GB was defined as segmental luminal narrowing of the GB body on computed tomography (CT) or magnetic resonance (MR) images, and HBS was examined 1 mo before or after CT or MR. Segmented GB was classified into 3 types based on the filling and emptying patterns of the proximal and distal segments according to the characteristics of HBS images, and GB ejection fraction (GBEF) was identified: Type 1 was defined as a normal filling and emptying pattern; Type 2 was defined as an emptying defect on the distal segment; and Type 3 was defined as a filling defect in the distal segment. RESULTS Segmented GB accounted for 63 cases (23.5%), including 36 patients (57.1%) with Type 1, 18 patients (28.6%) with Type 2, and 9 patients (14.3%) with Type 3 emptying pattern. Thus, approximately 43% of HBS images showed a discordant pattern as compared to anatomical imaging of segmented GB. Although there were no significant differences in clinical symptoms, rate of cholecystectomy, or pathological findings based on the type, most gallstones occurred in the distal segment. Reported GBEF was 62.50% ± 24.79% for Type 1, 75.89% ± 17.21% for Type 2, and 88.56% ± 7.20% for Type 3. Type 1 showed no difference in reported GBEF compared to the non-segmented GB group (62.50% ± 24.79% vs 67.40% ± 21.78%). In contrast, the reported GBEF was higher in Types 2 and 3 with defective emptying and filling when compared to Type 1 (80.11% ± 15.70% vs 62.57% ± 24.79%; P = 0.001). CONCLUSION In segmented GB, discordance in the filling patterns detected by HBS and anatomical imaging could lead to misinterpretation of GBEF. For this reason, clinicians should be cautious when interpreting HBS results in patients with segmented GB.

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Segmentation of the gallbladder: Effect on bile entry and exit and its clinical relevance in a patient with abdominal pain

Abstract: Segmentation of the gallbladder does not affect bile entry, but acting as a one-way valve, a fold or septum lowers emptying significantly, mostly from the distal segment.

Cited by 13 publications

References 10 publications

Gallbladder diaphragm: about a case

Gallbladder diaphragm: about a case

Prospective Assessment of Dynamic CT and MR Cholangiography in Functional Biliary Pain

Classification of hepatobiliary scintigraphy patterns in segmented gallbladder according to anatomical discordance

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