Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Gallbladder Mucocele Treatment & Management

  • Author: R Vijayaraghavan, MBBS, MS, FRCS(Edin); Chief Editor: John Geibel, MD, DSc, MSc, MA  more...
 
Updated: Jun 20, 2016
 

Approach Considerations

Contraindications to surgical treatment of gallbladder mucocele would obviously include any associated medical conditions or illnesses that preclude surgery. No absolute contraindication to surgical treatment exists.

Laboratory research suggests that chemical ablation of the gallbladder mucosa may be an alternative in patients who are medically unfit, elderly, or critically ill. A combination of ethanol, sodium tetradecyl sulfate, and mucosal exfoliant has been successfully tried in rats.[1, 2, 3, 10]

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

Next

Cholecystectomy and Cholecystostomy

Cholecystectomy is the definitive treatment for an obstructed gallbladder. Laparoscopic cholecystectomy (see the images below) 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 right-upper-quadrant (RUQ) pain and a positive hepato-iminodiacetic acid (HIDA) scan, symptom relief is more likely to occur after cholecystectomy than it is after medical treatment.[14]

Laparoscopic view of distended gallbladder in woma Laparoscopic view of distended gallbladder in woman aged 70 years with sudden onset of severe right upper abdominal pain.
Stone being extracted from cystic duct through sma Stone being extracted from cystic duct through small ductotomy.

Open cholecystectomy may be performed in patients who have a very large gallbladder, greatly thickened gallbladder walls, or an obliterated triangle of Calot. In such cases, laparoscopic dissection may be difficult and time-consuming.

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 during the same admission.

Intraoperative aspiration of the large gallbladder helps facilitate grasping the gallbladder for dissection. The aspirate is clear and watery or mucoid (white bile). Intraoperative cholangiography may be indicated, depending on clinical and investigative features that may suggest obstruction of the common bile duct.

Upon being opened, the gallbladder shows a white wall, clear and watery or mucoid content, a stone or stones impacted in the neck or cystic duct, a narrowed cystic duct, or a tumor or polyp causing obstruction of the neck of the gallbladder.

In some patients, percutaneous (ultrasonographically guided) or open cholecystostomy may be used as a temporary measure. Cholecystostomy is usually performed in cases where the patient is very sick or the dissection is technically very difficult; in such instances, if the surgeon is an expert, laparoscopic subtotal cholecystectomy also can be performed. A subsequent completion cholecystectomy may be carried out once the patient’s initial condition improves.[1]

Endoscopic ultrasound (EUS)-guided endoluminal approaches to gallbladder drainage have been described.[15]

Previous
 
Contributor Information and Disclosures
Author

R Vijayaraghavan, MBBS, MS, FRCS(Edin) Consultant General and Laparoscopic Surgeon, Department of Surgery, RMV Hospital, India

R Vijayaraghavan, MBBS, MS, FRCS(Edin) is a member of the following medical societies: International College of Surgeons, Royal College of Surgeons of Edinburgh

Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MSc, MA Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, Surgical Research, Department of Surgery, Yale-New Haven Hospital; American Gastroenterological Association Fellow

John Geibel, MD, DSc, MSc, 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, Society for Surgery of the Alimentary Tract

Disclosure: Received royalty from AMGEN for consulting; Received ownership interest from Ardelyx for consulting.

Acknowledgements

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.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References
  1. Agrawal S, Jonnalagadda S. Gallstones, from gallbladder to gut. Management options for diverse complications. Postgrad Med. 2000 Sep 1. 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. Anderson's Pathology. 10th ed. St. Louis, Mo: Mosby-Year Book; 1996. vol 2:

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

  6. 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. 2008 Sep. 38(9):1013-6. [Medline].

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

  8. Mofti AB, Al-Momen A, Suleiman SI, et al. The single gallbladder stone - is it innocent?. Ann Saudi Med. 1994 Nov. 14(6):471-3. [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. 1997 May. 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. 2008 Sep. 22(9):1959-64. [Medline].

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

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

  14. 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. 2009 Feb. 144(2):180-7. [Medline].

  15. Widmer J, Singhal S, Gaidhane M, Kahaleh M. Endoscopic ultrasound-guided endoluminal drainage of the gallbladder. Dig Endosc. 2014 Jul. 26 (4):525-31. [Medline].

 
Previous
Next
 
Image is from a 35-year-old woman who presented with recurrent episodes of right upper quadrant colic; most recent attack was 3 days before. Gross wall thickening is apparent; this is usually measured on anterior wall of gallbladder. Also apparent are clear content, stone in neck of gallbladder, and absence of pericholecystic fluid. All favor diagnosis of acute cholecystitis.
Stone in neck of gallbladder, with postacoustic shadowing. Minimal wall thickening and dilated gallbladder suggest mucocele.
Transverse scan shows stone in neck of gallbladder, with postacoustic shadowing. Minimal wall thickening and dilated gallbladder are also visible.
Transverse scans show layering of gallbladder wall; this suggests edema and indicates acute cholecystitis.
Longitudinal scan shows layering, with fluid in wall of gallbladder and impacted stone in neck of gallbladder. Intraluminal shadowing indicates sediments in fluid; image indicates acute cholecystitis with possible pyocele of gallbladder.
Cluster of impacted calculi in neck of gallbladder, minimal wall thickening, and clear content; this indicates mucocele of gallbladder.
Cluster of calculi with postacoustic shadowing in neck of gallbladder, normal wall, and clear content; this indicates mucocele of gallbladder.
Distended gallbladder with evidence of adhesions on its wall. Irregular surface indicates recurrent attacks of cholecystitis.
Yellowish aspirate from gallbladder of a 28-year-old woman who presented with features of right upper quadrant peritonitis. Slightly yellowish fluid was sterile and was rich in cholesterol.
Subserosal perforation of acute, emphysematous, acalculous cholecystitis in a 58-year-old diabetic man. Patient presented with features suggestive of ileus. He had high intrathoracic liver (and gallbladder), and clinical signs were atypical. Green color is unusual.
Laparoscopic view of distended gallbladder in woman aged 70 years with sudden onset of severe right upper abdominal pain.
Stone being extracted from cystic duct through small ductotomy.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.