Understanding Non-Functioning Gallbladder
I cannot provide an image, but I can describe the characteristics and clinical significance of a non-functioning gallbladder based on current medical evidence.
Imaging Characteristics
A non-functioning gallbladder appears on imaging studies as a gallbladder that fails to fill with radiotracer during cholescintigraphy or demonstrates absent contractility on cholecystokinin-stimulated studies. 1
Key Imaging Features:
Ultrasound findings: Distended gallbladder with thickened wall (≥4 mm), pericholecystic fluid, gallstones often impacted in the cystic duct, and positive sonographic Murphy's sign 1
Cholescintigraphy: Complete absence of gallbladder filling with radiotracer indicates cystic duct obstruction and non-function 1
CT findings: Distended gallbladder with edematous wall thickening, pericholecystic fluid, and potential complications like perforation or abscess formation 1
MRI/MRCP: Useful for excluding common bile duct stones and demonstrating cystic duct obstruction 1
Morphological Variants
Scleroatrophic Gallbladder (Most Dangerous Form)
The scleroatrophic gallbladder represents the most hazardous form of non-functioning gallbladder, occurring in 4.1% of patients with chronic calculous cholecystitis and carrying the highest risk for bile duct injury during surgery. 2
- Characterized by severe cicatricial and adhesive changes in the gallbladder wall and surrounding tissues 2
- Complete transection of the common bile duct occurred in 10 cases studied, with 6 of these involving scleroatrophic gallbladders 2
Other Forms:
- Micro-gallbladder: Seen in 8-30% of cystic fibrosis patients 3
- Calcified ("porcelain") gallbladder: Associated with increased cancer risk 4
Clinical Significance and Management
Risk Stratification
Non-functioning gallbladder significantly increases surgical risk, with bile duct injury rates of 0.94% in acute cholecystitis versus 0.25% in chronic cases. 2
High-Risk Criteria for Elective Cholecystectomy in Asymptomatic Patients:
- Non-functioning gallbladder on imaging 4
- Calculi >2 cm in diameter 4
- Calcified ("porcelain") gallbladder 4
- Life expectancy >20 years 4
- Women <60 years of age 4
- Concomitant diabetes 4
Management Algorithm
For acute cholecystitis with non-functioning gallbladder, early laparoscopic cholecystectomy (within 7-10 days of symptom onset) is the treatment of choice in operable patients. 1
Immunocompetent, Non-Critically Ill Patients:
- Adequate source control via cholecystectomy 1
- Single-shot antibiotic prophylaxis if early intervention 1
- No postoperative antibiotics if uncomplicated 1
- If complicated: antibiotics for 4 days post-surgery 1
Critically Ill or Immunocompromised Patients:
- Cholecystostomy as bridge to definitive surgery if multiple comorbidities or unfit for immediate surgery 1
- Antibiotic therapy: Piperacillin/tazobactam 6g/0.75g loading dose, then 4g/0.5g every 6 hours 1
- Antibiotic duration up to 7 days based on clinical response 1
Critical Pitfalls to Avoid
Long-term non-functioning gallbladder leads to cicatricial and adhesive processes that significantly complicate cholecystectomy and increase bile duct injury risk. 2
- Conversion to open cholecystectomy occurs more frequently with non-functioning gallbladders 1
- Gallbladder perforation risk increases with delayed intervention (2-11% incidence, 12-16% mortality) 1
- Scleroatrophic changes make anatomical identification extremely difficult 2
Special Populations
In cystic fibrosis patients, non-functioning gallbladders occur in 30% of cases, with operative mortality of 5% even with intensive perioperative management. 3