Introduction
Gallbladder diseases are common among people and are seen both in men and women. Increasing age, obesity, and pregnancy are the common predisposing risk factors for developing gallbladder disease. The most commonly occurring disease is the stone in the gallbladder or gallstone, which remains asymptomatic in most patients.
The presence of gallstone sometimes blocks the cystic duct - a duct or tube that carries bile from the gallbladder. This condition causes the development of gallbladder mucocele - a mucus-filled cyst that occurs as a swelling on the mucosa or lining of the gallbladder. Generally, cholecystectomy is the recommended line of treatment. When the patient is severely ill or cannot undergo surgery, then percutaneous drainage is preferred.
What Is Gallbladder Mucocele?
It is a condition caused by long-term blockage of the cystic duct - a duct or tube that carries bile from the gallbladder. The blockage occurs because of the presence of gallstones.
What Is Mucocele?
It is a mucus-filled cyst that occurs as a swelling on the mucosa or lining of the mouth, intestine, gallbladder, etc.
What Is the Other Name for Gallbladder Mucocele?
It is also called hydrops of the gallbladder.
What Causes Gallbladder Mucocele?
It commonly occurs due to:
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Calculous or acalculous cholecystitis - a condition caused by dysfunctioning and inflammation of the gallbladder.
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Pregnancy.
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Age, usually 40 years and above.
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Weight loss.
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Family history of gallstones.
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Sickle cell diseases.
What Are the Symptoms of Gallbladder Mucocele?
The symptoms of gallbladder mucocele are:
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Progressive pain in the upper right abdomen with deep palpation - murphy sign.
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Bloating.
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Nausea and vomiting.
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Decreased food intolerance.
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Pain in the back and/or shoulder.
What Is the Pathophysiology of Gallbladder Mucocele?
When the fluids in the gallbladder are stopped or slowed down, it increases the intraluminal pressure. This results in inflammation of the gallbladder and ischemia. If this pressure is not released, then the gallbladder develops changes such as a mucocele and perforations. The condition is then called acute cholecystitis - inflammation of the gallbladder.
How to Diagnose Gallbladder Mucocele?
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Physical Examination: The patient will have pain in the upper right abdomen with deep palpation. This is the classic sign of gallbladder mucocele. Mostly, the doctor can palpate the gallbladder, especially if the patient is thin.
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Patient’s History: The patient usually gives a history of heavy, spicy food intake that causes acute conditions and onset of symptoms.
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Lab Tests: Complete blood count (CBC) to examine the blood cell count and a comprehensive metabolic panel (CMP) to measure different substances in the blood are done and play an important role. The results may show increased levels of white blood cells and liver enzymes (bilirubin). The bilirubin enzyme levels of more than 2 mg/dL show bile duct stone.
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Imaging Tests: Ultrasound is the best diagnostic tool for this condition. It shows swollen and inflamed gallbladder, presence of gallstones in the cystic duct, or Hartman pouch - diverticulum at the neck of the gallbladder.
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Hepatobiliary Iminodiacetic Acid (Hida) Scan: It is an imaging procedure in which a radioactive tracer is injected, and the camera captures the images of the gallbladder. The contrast in the image or picture shows the presence of an abnormality, such as obstructions.
What Is Gallbladder Mucocele Treatment?
The gallbladder mucocele can be treated by two surgical approaches:
1) Cholecystectomy: It is a treatment of choice for gallbladder mucocele. It is a less invasive surgical procedure to remove the gallbladder. Depending on the situation, the physician may suggest the open or laparoscopic method. There are two types of cholecystectomy methods:
- Open or Traditional Method: An incision of four to six inches is made on the upper right side of the abdomen, and the surgeon removes the gallbladder.
- Laparoscopic Method: Two to four small incisions are made on the upper right side of the abdomen, and a laparoscope (thin tube with a camera) is inserted. The surgeon can visualize the internal structures on a screen and remove the gallbladder. It is a less invasive method and has a lesser recovery time.
2) Percutaneous Abscess Drainage: It is a technique of draining the abscess or fluids with the help of an imaging test, usually X-ray, ultrasound, or computed tomography, that guides the correct location to place the needles on the affected area. This method is recommended for elderly patients who cannot undergo cholecystectomy.
What Is the Differential Diagnosis of Gallbladder Mucocele?
The symptoms of gallbladder mucocele may represent or mimic other similar conditions such as:
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Peptic Ulcer Disease - Formation of sore on the wall or lining of stomach or intestines.
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Bowel Disease - A group of disorders that causes inflammation in the digestive tract.
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Gastroesophageal Reflux Disease - Backflow of stomach fluid into the food pipe (esophagus), causing irritation to the esophagus lining.
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Pulmonary Embolism - Blockage of arteries of the lungs.
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Musculoskeletal Disorders - Disorders or injuries of muscles, joints, etc.
What Are the Complications of Gallbladder Mucocele Surgery?
- Secondary Infection - It is an infection that occurs during or after the surgery,such as a surgical site infection.
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Empyema - A pocket filled with pus present in a cavity or space. It develops when the bacterial infection is not completely removed.
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Gangrenous Gallbladder - A serious complication that results in the death of gallbladder tissues (necrosis).
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Perforation - A hole or puncture in the wall of the gallbladder leading to abscess or fistula development.
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Emphysematous Cholecystitis - Formation of gas and infection in the gallbladder due to gas-producing microorganisms.
What Is the Gallbladder Mucocele Diet?
The patient who has developed gallbladder mucocele and gallstone should avoid food items that cause gallstones. Gallstones are diet-induced and may form because of high cholesterol, calcium salts, minerals, etc., in the diet. Therefore, the patient must take a high-fiber and low-fat diet. The patient must also stop the consumption of tobacco in any form, including tobacco chewing and smoking, because it may delay the healing process and may lead to failed or poor treatment outcomes.
Conclusion
It is important to understand the function of the gallbladder. If the functioning of the gallbladder is hampered due to any reason, it may lead to life-threatening complications. Gallstone is a commonly occurring gallbladder disease that remains asymptomatic in most patients. When the gallstone blocks the cystic duct, it causes the development of gallbladder mucocele or gallbladder hydrops. Murphy sign is the classic sign of gallbladder mucocele - progressive pain in the upper right abdomen with deep palpation for which cholecystectomy, more commonly laparoscopic cholecystectomy, and percutaneous abscess drainage are two available treatments.
