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Abnormal pathology in cholecystectomy patients with normal preoperative studies

Background: Right upper quadrant abdominal pain is a common complaint often associated with gallbladder disease. However, there may be a subset of patients with true gallbladder pathology who do not have definitively positive preoperative studies. We seek to demonstrate the outcomes in this patient subpopulation. 
 Methods: A retrospective chart review of all patients undergoing laparoscopic cholecystectomy for clinical history of biliary symptoms with classically “normal” ultrasound and HIDA scan were included. Patients were polled regarding their symptoms preoperatively and postoperatively at time of surgical follow-up. 
 Results: Thirty-three patients underwent minimally invasive cholecystectomy during the study period with normal preoperative evaluations despite clinical symptoms consistent with biliary pathology. Of these 33 patients, all reported resolution or significant improvement in symptoms post-operatively. 
 Conclusions: Currently available methods for the preoperative evaluation of gallbladder pathology may underdiagnose the true incidence of gallbladder disease, and cholecystectomy should be considered in these patients with a clinically significant history despite normal studies.