What is a stone at the neck of the gallbladder called?

Gallstone at the Neck of the Gallbladder: Hartmann's Pouch Stone

A stone located at the neck of the gallbladder is specifically referred to as a Hartmann's pouch stone. This is a clinically significant finding as stones in this location can lead to serious complications including obstruction, cholecystitis, and migration into the common bile duct.

Anatomical Significance

The neck of the gallbladder is a critical anatomical location:

• It connects the gallbladder body to the cystic duct
• Contains the spiral valves of Heister
• Includes Hartmann's pouch (a small outpouching on the inferior surface of the gallbladder neck)

Clinical Significance of Stones in This Location

Stones at the gallbladder neck warrant special attention for several reasons:

1. Increased risk of complications:

   • Higher likelihood of causing obstruction of the cystic duct
   • May lead to acute cholecystitis if they become impacted
   • Can migrate into the common bile duct causing choledocholithiasis

2. Diagnostic challenges:

   • Small stones in the gallbladder neck may be overlooked or mistaken for lateral cystic shadowing artifact (edge shadows) 1
   • May require imaging from multiple directions to avoid misdiagnosis
   • Careful ultrasound technique is needed to properly visualize this area

3. Technical considerations during surgery:

   • Stones at this location may complicate laparoscopic cholecystectomy
   • May require special techniques during dissection of the cystic pedicle
   • In some cases, can lead to difficult identification of the cystic duct-common bile duct junction

Imaging Considerations

When examining the gallbladder with ultrasound:

• The gallbladder should be systematically scanned with particular attention to the neck 1
• Multiple imaging windows (subcostal and intercostal) may help identify small stones in the neck region
• The gallbladder neck is conventionally displayed on the left side of the screen in long axis views 1

Clinical Implications

Stones at the gallbladder neck have important management implications:

• They are associated with a higher risk of developing symptoms or complications
• Studies show that 25.3% of patients with untreated common bile duct stones experience unfavorable outcomes (pancreatitis, cholangitis, biliary obstruction) 1
• When found during laparoscopic cholecystectomy, they may indicate a higher likelihood of concurrent common bile duct stones (up to 35% association) 2

Management Considerations

• Symptomatic patients with gallbladder neck stones should be offered stone extraction 1
• Laparoscopic cholecystectomy is the standard treatment for symptomatic gallstones 3
• Intraoperative cholangiography should be considered when stones are found in the neck/cystic duct region to rule out common bile duct stones 2

Pitfalls to Avoid

• Failure to properly visualize the gallbladder neck during ultrasound examination
• Mistaking gallbladder neck stones for edge shadows or artifacts
• Overlooking the possibility of concurrent common bile duct stones
• Aggressive manipulation during surgery that may cause stones to migrate into the common bile duct

Understanding the specific terminology and clinical significance of stones in the gallbladder neck location is essential for proper diagnosis, communication, and management planning.