A Rare Gallbladder Malformation Causing Recurrent Abdominal Pain. Abby Rhoads DO. 1 1. St. Luke's Family Medicine Residency, Anderson Campus, Easton PA. .

Chief Complaint Investigative Studies Abdominal Pain Figure 1. Right Upper Quadrant Ultrasound

History of Present Illness Bethlehe Conclusion m An 18 year old female presented for The patient was diagnosed with MSG by routine follow up for anxiety with self ultrasound appearance. She underwent an –cutting behavior and new onset EGD which demonstrated no abnormalities Allentow abdominal pain. SSRI therapy was and was given a trial with proton pumpn recently switched from Zoloft to inhibitors with no relief of her symptoms. Celexa. She was sent for surgical intervention and Her abdominal pain progressed to underwent laparoscopic cholecystectomy

Monro daily post-prandial epigastric and with confirmation of multiple septationse of RUQ pain. She did not identify the gallbladder. She did not have any specific food triggers, though she gallstones present at the time of surgery. admits her diet consists mostly of fast foods or processed foods. She She had complete resolution of symptomsAnderso n denied NSAID use. She denied after surgery. nocturnal pain symptoms. No reported changes to her bowel Clinical Pearls pattern including constipation, Quakertow Figure 1. n diarrhea, melena or hematochezia. : There is mild diffuse increased echogenicity with smooth echotexture, without 1. MSG is a rare congenital malformation No bloating or abdominal distention. Liver Parenchyma significant beam attenuation or loss of periportal echogenicity. Most consistent with mild hepatic with 29 adult and 20 pediatric cases She states she occasionally has described in literature to date. symptoms of early satiety . steatosis. 2. Most cases are detected as incidentalMiner Biliary: Numerous gallbladder septations. The gallbladder is normal in caliber. No wall thickening or s pericholecystic fluid. No stones or sludge identified. No sonographic Murphy's sign. No intrahepatic finding on RUQ ultrasound. Physical Exam biliary dilatation. CBD measures 3 mm. No choledocholithiasis. 3. Symptomatic patients present with biliary pain or colicky abdominal pain. no acute distress 4. The gold standard therapy is Appearance: Warre Heart: Discussion cholecystectomy. n Regular rate and rhythm without Multiseptate gallbladder (MSG) is a rare congenital malformation of the gallbladder. Twenty nine adult 5. Cholecystectomy seems to relieve the symptoms murmur cases are described in literature with a female predominance. Patients may be asymptomatic, however, Abdomen: symptomology often presents in the second decade of life. Patients will often present with symptoms Soft, mild epigastric tenderness, similar to biliary colic associated with gallstones such as recurrent right upper quadrant pain, dyspepsia, References negative Murphy's sign; otherwise nausea or vomiting. These symptoms may be aggravated by consumption of fatty meals. Physical exam non-tender without rebound or is often benign, or non-specific mild abdominal tenderness. Labratory workup also often does not show 1. “Diagnosis and Treatment of Multiseptate guarding, non-distended; normoactive abnormalities including normal bilirubin and liver function test, however, in this case there was a mild Gallbladder with Recurrent Abdominal bowel sounds; no masses, no elevation of total bilirubin. Due to normal physical exam and laboratory tests, it often results in frequent Pain.” Case Reports in Medicine. Volume organomegaly. emergency room visits until an ultrasound of the gallbladder is obtained. Extremities: multiple healing linear 2011. Article ID 162853. 2. E. Y. Rivera-Troche, M. G. Hartwig, and S. abrasions consistent with self-cutting MSG is believed to be caused from incomplete vacuolization of the developing gallbladder bud. It can be N. Vaslef, “Multiseptate gallbladder,” behavior associated with other anomalies including gallbladder ectopy, choledochal cysts, and anomalous Journal of Gastrointestinal Surgery, vol. biliopancreatic junction, with possible increased risk of developing cholangiocarcinoma. Ultrasound (US) 13, no. 9, pp. 1741–1743, 2009. evaluation of the gallbladder is usually sufficient to diagnose MSG. Other modalities such as CT, MRCP Laboratory Studies 3. Mirko Bertozzi. “Multiseptate gallbladder in and ERCP has also been described to confirm the diagnosis. On ultrasound, multiple linear echoes that Comprehensive metabolic panel: a child.” Journal of Pediatric Surgery Case can be seen crossing the gallbladder lumen, producing a honey-comb appearance, as seen in Figure 1 total bilirubin level of 1.57 mg/dL. Reports. Volume 45, June 2019, 101212. Liver function tests, creatinine and above. These septa within the gallbladder are the cause of recurrent abdominal pain due to impaired electrolytes were with in normal limits. motility leading to bile stasis. Literature has suggested treatment with ursodeoxycholic acid and low fat diets are ineffective at relieving recurrent abdominal pain. Several cases reports have shown complete resolution of symptoms after cholecystectomy.