Symptoms of a Retracted Gallbladder
A retracted gallbladder typically presents with right upper quadrant abdominal pain, often accompanied by a palpable gallbladder lump, which is a sign of complicated acute cholecystitis. 1
Clinical Presentation
The term "retracted gallbladder" most commonly refers to a contracted gallbladder seen in chronic cholecystitis or as a complication of acute cholecystitis. The key symptoms include:
Primary Symptoms
- Right upper quadrant abdominal pain - This is the hallmark presenting feature 1
- Murphy's sign - Focal tenderness over the gallbladder region, which can be elicited on physical examination or ultrasound 1
- Fever - Often present in acute inflammatory states 1
- Abdominal tenderness with a palpable gallbladder mass, which specifically indicates complicated cholecystitis 1
Associated Symptoms
- Nausea and vomiting - Common accompaniments to biliary pain 1
- Anorexia - Loss of appetite frequently occurs 1
Imaging Characteristics
On ultrasound examination, a retracted/contracted gallbladder demonstrates:
- Contracted or distended appearance - The gallbladder may appear either shrunken or enlarged 1
- Gallbladder wall thickening and edema 1
- Pericholecystic fluid (fluid surrounding the gallbladder) 1
- Gallstones, often impacted in the cystic duct 1
- Absence of pericholecystic fluid is typical in chronic cholecystitis specifically 1
Important Clinical Distinctions
In chronic cholecystitis, the diagnosis is particularly challenging on anatomic imaging, as the gallbladder may appear either contracted or distended, and pericholecystic fluid is usually absent 1. This contrasts with acute cholecystitis where pericholecystic fluid is more commonly present 1.
Complications to Consider
A retracted gallbladder with a palpable mass suggests complicated acute cholecystitis, which may include 1:
- Gangrenous changes
- Perforation
- Emphysematous cholecystitis
- Intraluminal hemorrhage
Ultrasound remains the investigation of choice for suspected gallbladder pathology, with reported 96% accuracy for detecting gallstones and the ability to identify wall thickening, pericholecystic fluid, and Murphy's sign 1. If ultrasound is equivocal or complications are suspected, CT with IV contrast or MRI/MRCP should be obtained 1.