Adenomyomatosis of gallbladder causing recurrent abdominal p
The present case has been reported in the Journal of Pediatrics. A 14-year-old girl was admitted for evaluation of recurrent abdominal pain lasting for 3 months. Pain episodes were described as severe, colicky, and umbilical; they occurred mainly during the day, but were also associated with repeated nocturnal awakenings, with no nausea, vomiting, or diarrhea. There was no history of fever, blood or mucus in the stools, constipation, anorexia, or weight loss.

Routine laboratory tests, including erythrocyte sedimentation rate, complete blood count, aspartate transaminase, alanine transaminase, gamma-glutamyl-transferase, total bilirubin, antitransglutaminase antibodies, urine analysis, fecal calprotectin, and Helicobacter pylori antigen search were all normal as well as the abdominal ultrasound, performed without previous fasting.

Considering the recent experience of her parents' divorce, a suspect of the functional disease was established. Owing to the history of night awakening and severe colicky pain, the abdominal ultrasound examination was repeated after 8 hours of fasting; the ultrasound image was suggestive of segmental adenomyomatosis of the gallbladder.

The girl underwent elective laparoscopic cholecystectomy. The surgery specimen measured 10.8 × 3.2 × 1.8 cm; macroscopically, the serosa and the mucosa were congested and the content consisted of fluid bile. The bottom was thickened (7 mm). Histologic examination confirmed the diagnosis of adenomyomatosis of the gallbladder. After the intervention, symptoms resolved.

Case highlights:-
- Diagnosis of adenomyomatosis of the gallbladder is confirmed by histologic evaluation.

- Cholecystectomy is performed in symptomatic patients; some authors suggest cholecystectomy even in asymptomatic patients because it remains unclear if there is a relationship between adenomyomatosis of the gallbladder and cancer of the gallbladder.

- Nocturnal pain is one of the red flags identifying an organic origin of abdominal pain, prompting the need for thorough investigations.

- Ultrasound examination of the hepatobiliary system should be performed on patients after 6-8 hours fasting because the ingestion of food stimulates gallbladder contraction, so gallbladder wall may seem to be thicker than normal.

- Furthermore, gastric distension and food residue can interfere with image quality.

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