eMedicine Specialties > General Surgery > Abdomen

Gallbladder Mucocele: Treatment

Author: Vijayaraghavan Rajagopalan, MBBS, MS, FRCS(Edin), Consultant General and Laparoscopic Surgeon, Department of Surgery, RMV Hospital, India
Contributor Information and Disclosures

Updated: Apr 9, 2009

Treatment

Medical Therapy

Do not consider a medical line of management with oral dissolution therapy in obstructed gallbladders. In acalculous hydrops observed in children as a part of a wider spectrum, expectant management may be considered.

Surgical Therapy

Cholecystectomy is the definitive treatment for an obstructed gallbladder. Laparoscopic cholecystectomy is the criterion standard procedure.11,12,13 (A 2009 study derived from database information and a literature review found evidence that even when gallstones are absent in patients with RUQ pain and a positive HIDA scan, symptom relief is more likely to occur following cholecystectomy than it is after medical treatment.14 ) 

Open cholecystectomy may be performed in patients with a very large gallbladder, with greatly thickened gallbladder walls, and with an obliterated Calot triangle, in whom laparoscopic dissection could be difficult and time-consuming.

In some patients, percutaneous (ultrasonographically guided) or open cholecystostomy may be used as a temporary measure; cholecystostomy is usually performed in patients who are very sick or when the dissection is technically very difficult. A subsequent completion cholecystectomy may be carried out once the initial condition improves.1

Preoperative Details

In patients with systemic signs and symptoms, preoperative management should include correction of hydration, nasogastric drainage (if necessary), and appropriate broad-spectrum antibiotic therapy. Preferably, cholecystectomy is carried out in the same admission.

Intraoperative Details

Intraoperative aspiration of the large gallbladder helps to facilitate grasping the gallbladder for dissection.

Intraoperative cholangiography is indicated, depending on clinical and investigative features that may suggest CBD obstruction.

Complications

  • Progressive inflammation leads to acute cholecystitis and all its attendant manifestations.
  • Bacterial contamination of the bile leads to an empyema of the gallbladder; the patient usually has a toxic and ill appearance. Gas-producing organisms may lead to an emphysematous gallbladder (see the image below); air bubbles in the wall of the gallbladder are visualized using plain radiography, ultrasonography, or CT scanning.

    • This intraoperative photograph shows a subserosal...

      This intraoperative photograph shows a subserosal perforation of an acute, emphysematous, acalculous cholecystitis in a 58-year-old diabetic man. He presented with features suggestive of ileus. He had a high intrathoracic liver (and gallbladder), and clinical signs were atypical. The green color is unusual.

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      This intraoperative photograph shows a subserosal...

      This intraoperative photograph shows a subserosal perforation of an acute, emphysematous, acalculous cholecystitis in a 58-year-old diabetic man. He presented with features suggestive of ileus. He had a high intrathoracic liver (and gallbladder), and clinical signs were atypical. The green color is unusual.

  • Perforation of the gallbladder with ensuing pericholecystic abscess or fluid collection and peritonitis is another complication; the diagnosis is usually strongly suspected on clinical grounds. Pseudomyxoma peritonei may result from the rupture of a true mucocele of the gallbladder.
  • Perforation of the gallbladder into the duodenum results in a cholecystenteric fistula. This occurs when the stone erodes into adjacent bowel, usually the duodenum. Gas in the biliary tree may be evident on plain radiographs of the abdomen or on ultrasonograms. If the stone is large, this may result in obstruction of the distal small bowel, leading to gallstone ileus.
  • Large gallbladders may compress the pylorus or duodenum, causing gastric outlet obstruction.1,9

More on Gallbladder Mucocele

Overview: Gallbladder Mucocele
Workup: Gallbladder Mucocele
Treatment: Gallbladder Mucocele
Follow-up: Gallbladder Mucocele
Multimedia: Gallbladder Mucocele
References
Further Reading
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References

  1. Agrawal S, Jonnalagadda S. Gallstones, from gallbladder to gut. Management options for diverse complications. Postgrad Med. Sep 1 2000;108(3):143-6, 149-53. [Medline].

  2. Feldman M, ed. Sleisenger and Fordtran's Gastrointestinal and Liver disease. 6th ed. Philadelphia, Pa: WB Saunders Company; 1998.

  3. Rosen P, Barkin R. Emergency Medicine: Concepts and Clinical Practice. 4th ed. St. Louis, Mo: Mosby-Year Book Inc; 1998.

  4. Damjanov I, Linder J. Diseases of the digestive system: gallbladder and extrahepatic ducts. In: Anderson's Pathology. vol 2. 10th ed. St. Louis, Mo: Mosby-Year Book; 1996.

  5. Wight DGD, Symmers WS, eds. Systemic pathology. In: The Liver, Biliary Tract and Exocrine Pancreas. vol 11. 3rd ed. Philadelphia, Pa: Churchill Livingstone; 1994.

  6. Rosai J. Rosai and Ackerman's Surgical Pathology. vol 1. 9th ed. New York, NY: Mosby; 2004:1039.

  7. Mofti AB, Al-Momen A, Suleiman SI, et al. The single gallbladder stone - is it innocent?. Ann Saudi Med. Nov 1994;14(6):471-3. [Medline].

  8. Maurer K, Unsinn KM, Waltner-Romen M, et al. Segmental bowel-wall thickening on abdominal ultrasonography: an additional diagnostic sign in Kawasaki disease. Pediatr Radiol. Sep 2008;38(9):1013-6. [Medline].

  9. Vijayaraghavan R, Belagavi CS. Double gallbladder with different disease entities: a case report. J Min Access Surg. 2006;2:23-6. [Full Text].

  10. Majeed AW, Reed MW, Stephenson TJ, Johnson AG. Chemical ablation of the gallbladder. Br J Surg. May 1997;84(5):638-41. [Medline].

  11. Georgiades CP, Mavromatis TN, Kourlaba GC, et al. Is inflammation a significant predictor of bile duct injury during laparoscopic cholecystectomy?. Surg Endosc. Sep 2008;22(9):1959-64. [Medline].

  12. Popkharitov AI. Laparoscopic cholecystectomy for acute cholecystitis. Langenbecks Arch Surg. Nov 2008;393(6):935-41. [Medline].

  13. [Best Evidence] Gurusamy KS, Samraj K, Fusai G, et al. Robot assistant for laparoscopic cholecystectomy. Cochrane Database Syst Rev. Jan 21 2009;CD006578. [Medline].

  14. [Best Evidence] Mahid SS, Jafri NS, Brangers BC, et al. Meta-analysis of cholecystectomy in symptomatic patients with positive hepatobiliary iminodiacetic acid scan results without gallstones. Arch Surg. Feb 2009;144(2):180-7. [Medline].

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Keywords

gallbladder mucocele, gallbladder, gallstones, gallstone, cholecystectomy, cholecystitis, gall stones, gallbladder disease, gallbladder surgery, gallbladder removal, cholelithiasis, gall bladder surgery, gall stone, HIDA scan, cystic duct, gallbladder hydrops, hydrops of the gallbladder, gallstone disease, overdistended gallbladder filled with mucoid or clear and watery content, outlet obstruction of the gallbladder

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Contributor Information and Disclosures

Author

Vijayaraghavan Rajagopalan, MBBS, MS, FRCS(Edin), Consultant General and Laparoscopic Surgeon, Department of Surgery, RMV Hospital, India
Vijayaraghavan Rajagopalan, MBBS, MS, FRCS(Edin) is a member of the following medical societies: International College of Surgeons and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

Medical Editor

Oscar Joe Hines, MD, Assistant Professor, Department of Surgery, University of California at Los Angeles School of Medicine
Oscar Joe Hines, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Endocrine Surgeons, American College of Surgeons, Association for Academic Surgery, Society for Surgery of the Alimentary Tract, and Society of American Gastrointestinal and Endoscopic Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michael A Grosso, MD, Consulting Staff, Department of Cardiothoracic Surgery, St Francis Hospital
Michael A Grosso, MD is a member of the following medical societies: American College of Surgeons, Society of Thoracic Surgeons, and Society of University Surgeons
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other

 
 
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