Hydrops of the Gallbladder: Definition and Clinical Significance
Hydrops of the gallbladder (also called gallbladder hydrops) is a progressive distention of the gallbladder in the absence of acute inflammation, bacterial infection, or gallstones, typically caused by cystic duct obstruction. 1
Clinical Definition and Pathophysiology
Gallbladder hydrops represents marked distention of an acalculous (stone-free), non-gangrenous gallbladder that occurs when bile flow is obstructed at the cystic duct level without the inflammatory changes seen in acute cholecystitis 2, 3
The condition involves progressive volume increase of the gallbladder due to continued mucus secretion by the gallbladder wall despite outflow obstruction 1
Unlike acute cholecystitis, hydrops lacks bacterial infection and the typical inflammatory markers, though patients may still present with abdominal symptoms 3
Common Clinical Associations
Pediatric Populations
Kawasaki disease is the most well-recognized cause of gallbladder hydrops in children, occurring as part of the abdominal manifestations of this vasculitic syndrome 2, 4, 5
Children with hydrops typically present with high fever, abdominal distention with guarding, and may have jaundice, mimicking surgical acute abdomen 2
In Kawasaki-associated hydrops, ultrasound shows a markedly distended gallbladder without stones, with normal intrahepatic biliary ducts 2, 4
Adult Populations
In adults, gallbladder hydrops can occur as a complication following biliary procedures, particularly after short-term biliary stenting for dominant strictures in primary sclerosing cholangitis 6
Diabetic patients with neuropathy are at particularly high risk for developing acalculous gallbladder hydrops, which can progress to spontaneous perforation and septic shock 1
Diagnostic Approach
Ultrasound is the diagnostic modality of choice, demonstrating a distended gallbladder without calculi, normal biliary ducts, and absence of gallbladder wall thickening typical of cholecystitis 2, 3, 4
The ultrasound findings help distinguish hydrops from acute cholecystitis, which typically shows pericholecystic fluid, gallbladder wall edema, and Murphy's sign 6
Serial ultrasound monitoring is valuable for tracking resolution of the hydrops 4, 5
Management Strategy
Conservative Management is Preferred
The preferred treatment for gallbladder hydrops is medical management with supportive care and close clinical monitoring, reserving surgery only for complications such as perforation or gangrene 2, 4, 5
In Kawasaki-associated hydrops, the gallbladder typically returns to normal size within 15 days with conservative management alone 4
Serial ultrasound evaluation allows safe nonoperative monitoring without untoward sequelae 5
Surgical Intervention
Surgery is indicated only for complications of hydrops including perforation, gangrene, or persistent symptoms despite medical management 2, 4
When surgery is necessary, simple cholecystostomy for drainage is safe and sufficient, though cholecystectomy may be performed 2
The clinical presentation can mimic surgical emergencies (appendicitis, intussusception), leading to diagnostic laparotomy in some cases before the correct diagnosis is established 3
Critical Pitfalls to Avoid
Do not confuse gallbladder hydrops with acute cholecystitis—hydrops lacks the inflammatory changes, bacterial infection, and typical ultrasound findings of cholecystitis 1, 3
Avoid unnecessary surgical intervention when the diagnosis is established by ultrasound, as most cases resolve with conservative management 4, 5
Maintain high clinical suspicion in diabetic patients with neuropathy, as they may have minimal symptoms despite severe pathology and risk spontaneous perforation 1
In children with fever and abdominal symptoms, consider Kawasaki disease and obtain ultrasound before proceeding to laparotomy 2