My 17 year old son has suffered from cyclic vomiting syndrome (CVS) since he was a toddler. He has had all the standard tests to rule out other causes, the most recent being a HIDA scan of the gallbladder and biliary system. The scan showed normal structures, and no evidence of stones or obstructions, but a contraction rate of only 30%. He has never had RUQ pain associated with his vomiting episodes, nor at any other time. Nevertheless, his doctor has scheduled him for a cholecystectomy (gall bladder removal). My son is understandably willing to try anything that might resolve his CVS, but I question whether there is any reason to think this surgery will help. I am also concerned that he may have problems after the cholecystectomy, since he will have many years to live without the normal services of his gallbladder.
It seems to me that his doctor is just grasping at straws to find something that might help the CVS. However, I have searched the internet for many hours, and I can't find a single reference to link poor contraction rate of the gall bladder to CVS or vomiting, nor can I find any references that indicates cholecystectomy is in order when RUQ pain is not present, and the gall bladder has always been asymptomatic.
My son's symptoms are consistent with the clinical picture of CVS described on the website, www.cvsaonline.org, and there is a family history of migraine on the maternal side, as is common with CVS. One symptom my son has that is not mentioned prominently on the CVS website is a sometimes lengthy prodromal period where he belches a sulphurous smelling gas, sometimes for hours before the vomiting starts. The vomitus then contains completely undigested (i.e., recognizable) food particles, even when his last meal was as much as 24 hours prior to the first vomiting episode, and no noticeable bile. Does this symptom imply gall bladder involvement in the CVS, or is it just an indication that his digestive processes temporarily comes to a halt in the hours prior to a vomiting attack? I should mention that his attacks have become less frequent as he approaches physical maturity. He went 8 full months without an attack (until this month), even though he was under considerable nervous stress during the period of remittance. His attacks used to occur at least once a month.
I would be grateful for your opinion about whether cholecystectomy is really indicated for my son at this time, if his only gall bladder dysfunction is the 30% contraction rate. I would also like to hear your thoughts about the relationship, if any, between the gall bladder and CVS, and your thoughts about the CVS itself. Is this prodromal period (with the foul belching) typical of CVS, or perhaps an indicator that we should be looking elsewhere for answers?