Porcelain gallbladder is not associated with gallbladder carcinoma

The surgical management of porcelain gallbladder is based on studies performed in 1931 and 1962, which indicated a correlation between porcelain gallbladder and carcinoma. We sought to evaluate the characteristics of patients with porcelain gallbladder and the risk for gallbladder carcinoma. The medical records of 10,741 cholecystectomies performed between 1955 and 1998 were reviewed and recorded. The pathology slides were evaluated for evidence of calcification and gallbladder carcinoma. Fifteen (0.14%) of 10,741 specimens were porcelain gallbladders. Ten patients (67%) had symptoms suggestive of biliary colic or cholecystitis. Five (33%) were asymptomatic and diagnosed incidentally. All specimens demonstrated chronic cholecystitis and partial calcification of the gallbladder wall. Nine (60%) had cholelithiasis. None had gallbladder carcinoma by recent review of pathologic material. During this same period 88 (0.82%) patients had gallbladder carcinoma, none of which showed calcification of the wall. This report represents the largest modern review of porcelain gallbladders. No carcinoma was identified among patients with porcelain gallbladder. In addition no patient with gallbladder carcinoma had calcified gallbladder. With a better understanding of the natural history of the porcelain gallbladder the current management of these patients may change.     

胆囊腺肌增生症伴胆囊囊肿一例

病人,女,44岁.主因间断性右上腹隐痛一年入院.该病人一年来右上腹隐痛间断发作,进油腻食物后加重,伴右肩部放散痛.     

Wandering gallbladder

A wandering gallbladder typically is attached to surrounding structures only by the cystic duct and its mesentery. Its characteristic propensity for torsion places it at risk for necrosis. A 70-year-old woman admitted to our hospital was found to have a wandering gallbladder. The possible clinical implications of this finding are discussed.     

Left-sided gallbladder

Transposition of the gallbladder to the left side without situs inversus viscerum is rare. These gallbladders are almost always situated under the left lobe of the liver between the IV and III segments or on the III segment to the left of the falciform ligament. One left positioned gallbladder was found in a consecutive series of 2536 patients undergoing microlaparotomy cholecystectomy for symptomatic gallstone disease in the "Moritz Kaposi" Teaching Hospital between 1990 and 2000, a prevalence of 0.04 per cent. Despite of the abnormal position of the gallbladder, the biliary pain experienced by the patient was on the right side. Preoperative diagnosis of this anomaly was not made in this patient despite preoperative sonography. The cystic duct may open in the common hepatic duct either side. In this anomaly safe microlaparotomy cholecystectomy or laparoscopic cholecystectomy can be performed.     

Bilobed gallbladder

We report a rare case of duplication anomaly of gallbladder in a female aged 17 years, who presented with right hypochondrial pain for 3 months. Ultrasound findings suggested multiple stones in gallbladder and per-operatively she was found to have bilobed gallbladder. This case emphasizes the need for complete removal of both gallbladders during initial surgery, as a failure of this may result in recurrence of symptoms and stones and a need for re-exploration.     

Multiseptate gallbladder

Nine cases of multiseptate gallbladder have been reported in the English literature. Another case is presented. We consider cholecystectomy the treatment of choice because it relieves the symptoms and avoids chronic infection and stone formation.