What is a Collapsed Gallbladder?
A collapsed gallbladder refers to a gallbladder that appears contracted or empty on imaging, typically indicating complete evacuation of bile, which is most commonly seen in the fasting state but can also suggest chronic inflammation, fibrosis, or complete cystic duct obstruction.
Physiologic vs Pathologic Collapse
Normal Physiologic State
- The gallbladder normally contracts and appears collapsed after meals or during prolonged fasting when bile has been expelled into the duodenum 1
- This represents normal gallbladder function and bile storage/release physiology
Pathologic Collapse
Chronic Cholecystitis
- Chronic inflammation leads to gallbladder wall fibrosis and scarring, resulting in a shrunken, contracted gallbladder that cannot distend properly 2, 3
- The gallbladder wall becomes thickened and rigid, losing its normal distensibility 3
- This is distinct from acute cholecystitis, where the gallbladder is typically distended with pericholecystic fluid present 4
Complete Cystic Duct Obstruction
- Long-standing cystic duct obstruction from gallstones can cause the gallbladder to become collapsed as bile is reabsorbed and cannot enter the gallbladder 1, 2
- This may progress through phases: initial distension during acute obstruction, followed by eventual collapse as inflammation becomes chronic 2
Acalculous Disease
- In rare cases, a collapsed gallbladder may be seen in acalculous cholecystitis or functional gallbladder disorders, particularly in critically ill patients 1
- "Hanging" or elongated gallbladders with poor function may appear collapsed on imaging despite causing typical biliary symptoms 5
Clinical Significance
Diagnostic Considerations
- Ultrasonography is the first-line imaging modality to evaluate gallbladder appearance, though a collapsed gallbladder can make visualization of stones or wall abnormalities difficult 1
- A collapsed gallbladder with wall thickening suggests chronic rather than acute cholecystitis, as acute cholecystitis typically shows distension and pericholecystic fluid 4
Important Pitfall
- Disease can exist even when the gallbladder appears normal or collapsed on imaging—chronic cholecystitis, gallstones, and cholesterolosis can escape detection by standard imaging 6
- In patients with typical biliary symptoms but normal imaging including a collapsed gallbladder, pathologic examination after cholecystectomy may still reveal chronic inflammation or cholesterolosis 6
Management Implications
- The finding of a collapsed gallbladder does not exclude significant pathology and should be interpreted in the clinical context of symptoms and other imaging findings 6, 3
- For symptomatic patients with a collapsed gallbladder and typical biliary pain, cholecystectomy may still be indicated even without visible stones 5, 6