Duplex Assessment of Mesenteric Arteries Within a Targeted Negative Gallbladder Sonogram

Gallbladder sonograms are commonly performed on patients complaining of postprandial pain, nausea, vomiting, weight loss, and diarrhea. Such symptoms may eventually lead to fear of food, as do symptoms associated with celiac stenosis, median arcuate ligament (MAL) syndrome, and superior mesenteric artery (SMA) syndrome (Table 1). A typical gallbladder sonogram protocol includes the aorta, inferior vena cava, pancreas, liver, right kidney, gallbladder, and bile ducts. Because the celiac and superior mesenteric arteries are readily accessible as early aortic branches within the established protocol, Doppler analysis of these vessels could be included for targeted patients with symptoms associated with celiac or SMA flow velocity disturbances.

Table 1.

Disease Symptom Comparison

Disease	Postprandial Pain	Nausea/ Vomiting	Weight Loss	Diarrhea	“Fear of Food”
Cholecystitis	X	X	X	X	X
Median arcuate ligament compression syndrome	X	X	X	X	X
Superior mesenteric artery syndrome	X	X	X	X	X

The researchers posit that symptomatic patients at greater risk for MAL and SMA syndromes with negative gallbladder sonograms will exhibit, in significant proportion, flow disturbances in either or both of the celiac or superior mesenteric arteries or decreased aortomesenteric angles. Original patient data were documented according to sex, age, symptoms, and gallbladder sonogram results. The study thereafter targeted female patients only. If the gallbladder was negative for disease findings, Doppler velocities were recorded for the celiac and SMA, along with record of the aortomesenteric angle.

Preliminary study findings of 41 patients, 24 female, revealed compelling evidence that targeting the mesenteric arteries of female patients with negative gallbladder sonograms may demonstrate significance when added to the gallbladder protocol. Preliminary results have revealed that 33% of females with negative gallbladder examinations have demonstrated elevated peak systolic velocities and decreased aortomesenteric angles of less than 25 degrees, 11% with poststenotic turbulence (Figure 1).

Figure 1.

Preliminary study findings of 41 patients (24 female). Thirty-three percent of females with negative gallbladder findings demonstrated elevated peak systolic velocities (PSV) and decreased aortomesenteric angles of less than 25 degrees.