Hyperkinetic gallbladder: an indication for cholecystectomy?

Cholecystectomy may benefit children with biliary colic without stones on ultrasound (US) or low ejection fraction on cholecystokinin-hepatobiliary iminodiacetic acid (CCK-HIDA) scan. Children with symptomatic biliary colic and abnormal HIDA scan, specifically those with high ejection fractions, may benefit from cholecystectomy. All patients younger than 18 years old undergoing cholecystectomy from 2008 to 2012 in our practice were reviewed. Patients with a negative US and CCK-HIDA ejection fractions 80 per cent or greater were included in the study. Patient data were extracted from charts, whereas postoperative symptoms were obtained by phone interviews. Of 174 patients who underwent cholecystectomy, 12 (7%) met study criteria. All patients (12 of 12) had evidence of cholecystitis on the final pathology note. All 11 patients contacted had relief of colic after gallbladder removal with a mean follow-up of 16 months. A subset of pediatric patients with high ejection fractions on CCK-HIDA and symptomatic biliary colic may have symptomatic relief with cholecystectomy.

Congenital esophageal diverticulum - a case report and review of literature.

Zenker's Diverticulum (ZD) is a false diverticulum located in the posterior esophagus between the cricopharyngeus and inferior constrictor. Few cases have been reported in the pediatric population. Congenital esophageal diverticulum is commonly associated with additional esophageal anatomical deformities or iatrogenic injury in the early post-natal period. TD was born at 39 5/7 weeks gestational age and did well at home with the exception of "choking during feeds 2-4 times per day" with mild cyanosis. Flexible bronchoscopy performed under sedation revealed a retropharyngeal mass protruding towards the epiglottis resulting in upper airway obstruction. Esophogram demonstrated upper esophageal diverticulum. Patient underwent left neck dissection with cervical myotomy from the cricopharyngeus to the level of the thoracic inlet. A postoperative repeat esophogram illustrated resolution of the diverticulum. Currently, the patient is 9 months postoperative and is tolerating feeds by mouth, gaining weight and has no pulmonary symptoms. There have been a few reports of ZD in children occurring in combination with anatomical abnormalities or esophageal manipulation. This case is one of the youngest reported and occurs in a patient without any previous manipulation of the esophagus. This condition is exceedingly rare but should be included in the differential diagnosis for both pharyngoesophageal and tracheal symptoms.