Bishop W P, Kao S C
Department of Pediatrics, College of Medicine, University of Iowa, Iowa City 52242.
J Pediatr Gastroenterol Nutr. 1991 Oct;13(3):307-11. doi: 10.1097/00005176-199110000-00013.
Acute hydrops of the gallbladder is a well-recognized complication of Kawasaki syndrome. We report a case of a child with this syndrome whose gallbladder hydrops slowly resolved after intravenous gamma-globulin therapy. However, he continued to experience postprandial right upper quadrant abdominal pain. Hepatobiliary scintigraphy revealed normal filling of the gallbladder but marked impairment of meal-stimulated gallbladder emptying. Endoscopy with biopsy of the esophagus, stomach, and duodenum was normal, ruling out peptic complications of his aspirin therapy. This child's discomfort improved slowly over several months, finally ending approximately 6 months after the onset of his illness. A repeat gallbladder emptying study done ultrasonographically at that time revealed near-normal meal-stimulated gallbladder emptying. We conclude that poor emptying of the gallbladder may be associated with prolonged abdominal pain in Kawasaki syndrome. Meal-stimulated gallbladder emptying can be assessed by a simple ultrasonographic technique and should be considered in any patient with Kawasaki syndrome and abdominal pain.
急性胆囊积液是川崎病一种广为人知的并发症。我们报告一例患有该综合征的儿童病例,其胆囊积液在静脉注射丙种球蛋白治疗后缓慢消退。然而,他仍持续出现餐后右上腹腹痛。肝胆闪烁造影显示胆囊充盈正常,但进餐刺激后胆囊排空明显受损。食管、胃和十二指肠的内镜检查及活检结果正常,排除了阿司匹林治疗导致的消化性并发症。该患儿的不适在数月内缓慢改善,最终在发病约6个月后结束。当时通过超声检查进行的重复胆囊排空研究显示,进餐刺激后胆囊排空接近正常。我们得出结论,胆囊排空不良可能与川崎病患者的长期腹痛有关。进餐刺激后的胆囊排空可通过简单的超声技术进行评估,对于任何患有川崎病且伴有腹痛的患者都应考虑这一点。