From the Research
Introduction to Folded Gallbladder with Adenomyomatosis
A folded gallbladder with adenomyomatosis is a benign condition characterized by thickening of the gallbladder wall and formation of intramural diverticula, known as Rokitansky-Aschoff sinuses (RAS) 1, 2. This condition is often asymptomatic but can cause right upper quadrant pain in some cases.
Implications of Adenomyomatosis
The implications of adenomyomatosis include:
- Thickening of the gallbladder wall, which can lead to the formation of RAS 1
- Potential risk of malignancy, although the disease is still classified as benign 3
- Recurrent right upper quadrant pain, which can be a cause of concern for patients 4
- Difficulty in visualizing coexisting malignancies, especially in diffuse adenomyomatosis 1
Diagnosis and Treatment
Diagnosis of adenomyomatosis is typically made using imaging techniques such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) 1, 4. Characteristic features on imaging include "comet-tail" artefacts and "twinkling" artefacts on ultrasound, "pearl-necklace sign" on MRI, and "rosary sign" on CT 1.
Treatment Options
Treatment options for adenomyomatosis include:
- Cholecystectomy, which is recommended for symptomatic patients and those with segmental or diffuse adenomyomatosis due to the increased risk of malignancy 1, 3
- Wait-and-see policy for asymptomatic patients with low-risk adenomyomatosis patterns, with regular follow-ups using ultrasound 3
- Differential diagnosis from gallbladder malignancies, especially when there is no image showing a "comet tail" of cholesterol crystals in the wall 5
Caveats and Considerations
It is essential to note that: