Multiseptate gallbladder in an adolescent patient with chronicabdominal pain ultrasonography and magnetic resonancecholangiopancreatography findings

Abstract

A 12-year-old girl, who had complaints of ongoing nausea and vomiting for 2 years accompanied by chronic right upper quadrant pain, was admitted to our hospital. Her medical story did not include fever, jaundice, constipation, diarrhoea, acholic stool, sickle-cell anaemia or other blood disorders. On physical examination, we observed tenderness in the right upper quadrant. The patient's complete blood count, urinalysis, transaminases, bilirubin, amylase, lactic dehydrogenase, and alkaline phosphatase levels were normal. We did not detect any parasites in the microscopic examination of the excrement sample. The abdominal US applied on an empty stomach (Logiq 8S, GE Healthcare, Wisconsin, USA) showed multiple septations 1.6x3.8 cm in size located inside lumen in the gallbladder causing honeycomb formations. Color Doppler US did not show blood supply in the septa. The gallbladder wall thickness was normal and there was no intraluminal stones or mud. Intra- and extrahepatic bile ducts were also normal (Figures 1a and 1b). The US applied after approximately an hour of food intake did not reveal any changes with regards to the size and wall thickness of the gallbladder though the patient developed pain in the right upper quadrant. The MRCP (1.5 T MR, Siemens, Somatom, Germany. 3D, TSE coronal, TR 1800 ms, TE: 350 ms, FA: 908, thickness: 3 mm, NSA: 2, FOV: 300/300 mm, image matrix: 118/512) evaluation displayed irregularities in the gallbladder wall as well as hypointense septa extending into the lumen. There were no abnormalities in the bile duct or pancreatic anomalies (Figures 2a and 2b). Chronic abdominal pain solely induced by the gallbladder is rare in childhood. Cholecystitis and cholelithiasis, on the other hand, are usually accompanied by systemic diseases, bacterial and parasitic infections, haemolytic conditions or chronic gastrointestinal diseases. Although single or multiple gallbladder septations are uncommon, they can bring about recurrent right upper quadrant pain (2, 3).