Adenomyomatosis of the Gallbladder

By usmlevideoss

Introduction

Adenomyomatosis of the gallbladder is a benign, non-inflammatory condition characterized by hyperplastic changes in the gallbladder wall, including thickening and the formation of intramural diverticula (Rokitansky-Aschoff sinuses). It is often asymptomatic and discovered incidentally on imaging.

Etiology

The exact cause of adenomyomatosis is unknown, but it is associated with chronic gallbladder inflammation and gallstones in some cases.

Epidemiology

  • Prevalence: Found in approximately 9–12% of cholecystectomy specimens.
  • Commonly diagnosed in middle-aged and older adults.
  • Equal prevalence in men and women.

Pathophysiology

  1. Hyperplasia of the gallbladder mucosa leads to invagination into the muscular layer, forming Rokitansky-Aschoff sinuses.
  2. Gallbladder wall thickening results from smooth muscle proliferation.
  3. May be associated with gallstones or chronic inflammation.

Clinical Manifestations

  • Asymptomatic (most cases): Found incidentally during imaging or surgery.
  • Symptomatic cases:
  • Intermittent right upper quadrant (RUQ) pain.
  • Symptoms similar to biliary colic if gallstones are present.
  • No systemic symptoms unless complications arise.

Diagnosis

  • Imaging:
  • Ultrasound: Thickened gallbladder wall with comet-tail artifacts (indicative of Rokitansky-Aschoff sinuses).
  • CT scan or MRI: May show gallbladder wall thickening and cystic spaces.
  • MRCP: Used to evaluate biliary anatomy if other abnormalities are suspected.
  • Histopathology (if cholecystectomy is performed): Confirms hyperplastic changes.

Treatment

  • Asymptomatic adenomyomatosis: No treatment required.
  • Symptomatic cases:
  • Cholecystectomy may be performed if symptoms are due to gallstones or persistent biliary colic.
  • Adenomyomatosis itself does not mandate surgery unless malignancy is suspected.

Prognosis

  • Excellent prognosis for most patients.
  • No strong evidence links adenomyomatosis to an increased risk of gallbladder cancer.

SUPERPoint

Adenomyomatosis is a benign condition of the gallbladder that rarely requires treatment unless symptomatic or complicated by gallstones or suspicion of malignancy.

SUPERFormula

Patient is asymptomatic + Ultrasound gallbladder reveals thickened gallbladder wall as an incidental finding + intramural diverticula (Rokitansky-Aschoff sinuses) + no cancer risk + no further treatment = Adenomyomatosis of the gallbladder.