*Gallbladder Mucocele*
The term gallbladder mucocele refers to an overdistended gallbladder filled with mucoid or clear and watery content. Usually noninflammatory, it results from outlet obstruction of the gallbladder and is commonly caused by an impacted stone in the neck of the gallbladder or in the cystic duct.
*Signs and symptoms*
Symptoms of a gallbladder mucocele include the following:
Right-upper-quadrant (RUQ) pain or epigastric pain and discomfort
Nausea and vomiting
The following suggest other conditions:
Continuance of pain or persistence of tenderness for longer than 6 hours – Acute cholecystitis
Fever and chills – Infected bile, with possible gallbladder empyema
Jaundice – Coexisting obstruction of the common bile duct (CBD)
Physical findings include the following:
Minimal acute inflammatory signs
Large, palpable, somewhat tender mass
*Diagnosis*
Laboratory studies that may be helpful include the following:
White blood cell (WBC) count – Mild leukocytosis with a left shift is common; higher counts suggest acute cholecystitis or infected bile
Bilirubin – Usually within the reference range but may be mildly raised with Mirizzi syndrome or associated CBD obstruction or cholangitis
Liver enzymes – Usually within the reference range, though alkaline phosphatase may be mildly elevated; large increases suggest an obstructed CBD
Serum amylase levels – Usually within the reference range; large increases suggests acute pancreatitis
Imaging modalities that may be considered include the following:
Ultrasonography – Extremely sensitive in detecting gallbladder stones and identifying intrahepatic biliary tree dilatation
Plain radiography of the abdomen – Nonspecific, used only as a guideline in differential diagnosis
Scintigraphy (hepato-iminodiacetic acid [HIDA] scanning) – Capable of offering only indirect evidence but possible worth considering in obscure cases
Computed tomography (CT) – Indicated when the diagnosis is unclear or other associated conditions or complications are present that must be assessed
Magnetic resonance cholangiopancreatography (MRCP)
*Management*
Surgery is definitive treatment for gallbladder obstruction, and no absolute contraindication to such treatment exists. However, the following factors may be considered:
The presence of any associated medical conditions or illnesses that preclude surgery would constitute a contraindication to surgical treatment.
Laboratory research suggests that chemical ablation of the gallbladder mucosa may be an alternative in patients who are medically unfit, elderly, or critically ill
Surgical options include the following:
*Laparoscopic cholecystectomy* – The criterion standard procedure
Open cholecystectomy – An option for patients who have a very large gallbladder, greatly thickened gallbladder walls, or an obliterated triangle of Calot
Percutaneous or open cholecystostomy – A temporary measure, usually performed when the patient is very sick or the dissection is technically very difficult and followed by a completion cholecystectomy
Laparoscopic subtotal cholecystectomy – An option for very difficult gallbladder dissections in which the inflammation is very severe and in the region of the neck
*Source* – Medscape
https://emedicine.medscape.com/article/195165-overview
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