Porcelain gallbladder

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Porcelain gallbladder
Other namesCalcified gallbladder
Porcelain gallbladder.png
Porcelain gallbladder on X-ray
Specialty Gastroenterology, hepatology   OOjs UI icon edit-ltr-progressive.svg

Porcelain gallbladder is a calcification of the gallbladder believed to be brought on by excessive gallstones, although the exact cause is not clear. As with gallstone disease in general, this condition occurs predominantly in overweight female patients of middle age. It is a morphological variant of chronic cholecystitis. Inflammatory scarring of the wall, combined with dystrophic calcification within the wall transforms the gallbladder into a porcelain-like vessel. Removal of the gallbladder (cholecystectomy) is the recommended treatment.

Contents

Symptoms and signs

Symptoms are similar to gallstones and can include abdominal pain (especially after eating), jaundice, and vomiting. Porcelain gallbladder can also be asymptomatic and discovered on imaging obtained for a different reason.

Association with cancer

The assertion that porcelain gallbladder increases the incidence of gallbladder cancer is widely taught in medical schools but is based on studies from 1931 and 1962. [1] A prominent study aid for surgical residents even states that the risk of cancer in a porcelain gallbladder is 15%. [2] The precise nature of the association between gallbladder cancer and porcelain gallbladder is uncertain. Two articles published in 2001 examined the association between cancer of the gallbladder and calcified gallbladder. The first study reviewed 10,741 cholecystectomies and found that the 88 patients with gallbladder cancer did not have calcified gallbladders while the 15 patients with porcelain gallbladders did not have gallbladder cancer. [1] The second study reviewed 25,900 gallbladder specimens and found 150 patients with cancer and 44 patients with calcified gallbladders of two types (intramural calcification and selective mucosal calcification). [3] The selective mucosal calcification group showed a 7% incidence of cancer with a significant odds ratio of 13.89. [3]

An article published in 2013 reviewed 111 studies and found 340 patients with gallbladder wall calcification showed a 21% overall rate of gallbladder malignancy; however, when studies with obvious selection bias were excluded the rate of gallbladder malignancy fell to 6%. [4] Comparatively, a matched cohort without gallbladder calcification showed a 1% rate of gallbladder malignancy.

Diagnosis

Abdominal radiography (X-ray), abdominal ultrasound or CT scan.[ citation needed ]

Treatment

Due to the increased risk for gallbladder cancer, the recommended treatment is cholecystectomy which usually includes pre-operative or intra-operative imaging of the biliary tree. Cholecystectomy may be performed via an open incision or via laparoscopic methods, but gallbladder anatomy and consistency may complicate the operation. [5]

Based on evidence in the current literature, a prophylactic cholecystectomy is not routinely recommended for all patients with porcelain gallbladder and should be restricted to those with conventional indications, such as young patients [6]

Related Research Articles

Laparoscopy Minimally invasive operations within the abdominal or pelvic cavities

Laparoscopy is an operation performed in the abdomen or pelvis using small incisions with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.

Gallbladder Organ in humans and other vertebrates

In vertebrates, the gallbladder, also known as the cholecyst, is a small hollow organ where bile is stored and concentrated before it is released into the small intestine. In humans, the pear-shaped gallbladder lies beneath the liver, although the structure and position of the gallbladder can vary significantly among animal species. It receives and stores bile, produced by the liver, via the common hepatic duct, and releases it via the common bile duct into the duodenum, where the bile helps in the digestion of fats.

Gallstone Disease where stones form in the gallbladder

A gallstone is a stone formed within the gallbladder out of precipitated bile components. The term cholelithiasis may refer to the presence of gallstones or to any disease caused by gallstones, and choledocholithiasis refers to presence of migrated gallstones within bile ducts.

Cholecystitis Medical condition

Cholecystitis is inflammation of the gallbladder. Symptoms include right upper abdominal pain, pain in the right shoulder, nausea, vomiting, and occasionally fever. Often gallbladder attacks precede acute cholecystitis. The pain lasts longer in cholecystitis than in a typical gallbladder attack. Without appropriate treatment, recurrent episodes of cholecystitis are common. Complications of acute cholecystitis include gallstone pancreatitis, common bile duct stones, or inflammation of the common bile duct.

Hysterectomy Surgical removal of the uterus

Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries (oophorectomy), Fallopian tubes (salpingectomy), and other surrounding structures.

Cholecystectomy Surgical removal of the gallbladder

Cholecystectomy is the surgical removal of the gallbladder. Cholecystectomy is a common treatment of symptomatic gallstones and other gallbladder conditions. In 2011, cholecystectomy was the eighth most common operating room procedure performed in hospitals in the United States. Cholecystectomy can be performed either laparoscopically, or via an open surgical technique.

Cholangiocarcinoma Bile duct adenocarcinoma

Cholangiocarcinoma, also known as bile duct cancer, is a type of cancer that forms in the bile ducts. Symptoms of cholangiocarcinoma may include abdominal pain, yellowish skin, weight loss, generalized itching, and fever. Light colored stool or dark urine may also occur. Other biliary tract cancers include gallbladder cancer and cancer of the ampulla of Vater.

Courvoisier's law states that a painless palpably enlarged gallbladder accompanied with mild jaundice is unlikely to be caused by gallstones. Usually, the term is used to describe the physical examination finding of the right-upper quadrant of the abdomen. This sign implicates possible malignancy of the gallbladder or pancreas and the swelling is unlikely due to gallstones.

Pancreaticoduodenectomy

A pancreaticoduodenectomy, also known as a Whipple procedure, is a major surgical operation most often performed to remove cancerous tumours from the head of the pancreas. It is also used for the treatment of pancreatic or duodenal trauma, or chronic pancreatitis. Due to the shared blood supply of organs in the proximal gastrointestinal system, surgical removal of the head of the pancreas also necessitates removal of the duodenum, proximal jejunum, gallbladder, and, occasionally, part of the stomach.

Common bile duct stone Medical condition

Common bile duct stone, also known as choledocholithiasis, is the presence of gallstones in the common bile duct (CBD). This condition can cause jaundice and liver cell damage. Treatment is by choledocholithotomy and endoscopic retrograde cholangiopancreatography (ERCP).

Gallbladder cancer Medical condition

Gallbladder cancer is a relatively uncommon cancer, with an incidence of fewer than 2 cases per 100,000 people per year in the United States. It is particularly common in central and South America, central and eastern Europe, Japan and northern India; it is also common in certain ethnic groups e.g. Native American Indians and Hispanics. If it is diagnosed early enough, it can be cured by removing the gallbladder, part of the liver and associated lymph nodes. Most often it is found after symptoms such as abdominal pain, jaundice and vomiting occur, and it has spread to other organs such as the liver.

Gastrointestinal cancer refers to malignant conditions of the gastrointestinal tract and accessory organs of digestion, including the esophagus, stomach, biliary system, pancreas, small intestine, large intestine, rectum and anus. The symptoms relate to the organ affected and can include obstruction, abnormal bleeding or other associated problems. The diagnosis often requires endoscopy, followed by biopsy of suspicious tissue. The treatment depends on the location of the tumor, as well as the type of cancer cell and whether it has invaded other tissues or spread elsewhere. These factors also determine the prognosis.

Ascending cholangitis Medical condition

Ascending cholangitis, also known as acute cholangitis or simply cholangitis, is inflammation of the bile duct (cholangitis), usually caused by bacteria ascending from its junction with the duodenum. It tends to occur if the bile duct is already partially obstructed by gallstones.

Postcholecystectomy syndrome (PCS) describes the presence of abdominal symptoms after a cholecystectomy.

Biliary colic Medical condition in which gallstones cause acute pain

Biliary colic, also known as symptomatic cholelithiasis, a gallbladder attack or gallstone attack, is when a colic occurs due to a gallstone temporarily blocking the cystic duct. Typically, the pain is in the right upper part of the abdomen, and can be severe. Pain usually lasts from 15 minutes to a few hours. Often, it occurs after eating a heavy meal, or during the night. Repeated attacks are common.

Gallbladder disease Medical condition

Gallbladder diseases are diseases involving the gallbladder and is closely linked to biliary disease, with the most common cause being gallstones (cholelithiasis).

Gallbladder polyp Medical condition

Gallbladder polyps are growths or lesions resembling growths in the wall of the gallbladder. True polyps are abnormal accumulations of mucous membrane tissue that would normally be shed by the body.

Adenomyomatosis Medical condition

Adenomyomatosis is a benign condition characterized by hyperplastic changes of unknown cause involving the wall of the gallbladder. Adenomyomatosis is caused by an overgrowth of the mucosa, thickening of the muscular wall, and formation of intramural diverticula or sinus tracts termed Rokitansky–Aschoff sinuses, also called entrapped epithelial crypts.

Surgical extirpation is a type of occasionally invasive surgical procedure in which an organ or tissue is completely removed or eradicated. Extirpation is used in the treatment of various medical conditions and also as a means to prevent the spread of cancer.

Choledochoduodenostomy

Choledochoduodenostomy (CDD) is a surgical procedure to create an anastomosis, a surgical connection, between the common bile duct (CBD) and an alternative portion of the duodenum. In healthy individuals, the CBD meets the pancreatic duct at the ampulla of Vater, which drains via the major duodenal papilla to the second part of duodenum. In cases of benign conditions such as narrowing of the distal CBD or recurrent CBD stones, performing a CDD provides the diseased patient with CBD drainage and decompression. A side-to-side anastomosis is usually performed.

References

  1. 1 2 Towfigh, S; McFadden, DW; Cortina, GR; Thompson Jr, JE; Tompkins, RK; Chandler, C; Hines, OJ (2001). "Porcelain gallbladder is not associated with gallbladder carcinoma". The American Surgeon. 67 (1): 7–10. PMID   11206901.
  2. ↑ Fiser, Steven (2013). The ABSITE Review (4th ed.). LWW. ISBN   978-1451186901.
  3. 1 2 Stephen, Antonia E.; Berger, David L. (2001). "Carcinoma in the porcelain gallbladder: A relationship revisited". Surgery. 129 (6): 699–703. doi:10.1067/msy.2001.113888. PMID   11391368.
  4. ↑ Schnelldorfer, Thomas (June 2013). "Porcelain Gallbladder: A Benign Process or Concern for Malignancy?". Journal of Gastrointestinal Surgery. 17 (6): 1161–1168. doi:10.1007/s11605-013-2170-0. PMID   23423431.
  5. ↑ Tomioka, T.; Tajima, Y.; Inoue, K.; Onizuka, S.; Ikematsu, Y.; Kanematsu, T. (March 1997). "Laparoscopic Cholecystectomy Is a Safe Procedure for the Treatment of Porcelain Gallbladder". Endoscopy. 29 (3): 225. doi: 10.1055/s-2007-1004172 . PMID   9201480.
  6. ↑ Machado, Norman O. (November 2016). "Porcelain Gallbladder". Sultan Qaboos University Medical Journal. 16 (4): e416–e421. doi:10.18295/squmj.2016.16.04.003. ISSN   2075-051X. PMC   5135451 . PMID   28003886.
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