Adenomyomatosis of the gallbladder is a condition often encountered during imaging tests or after gallbladder removal. This common finding involves changes to the gallbladder wall. It is considered a benign condition. For many individuals, adenomyomatosis is discovered incidentally.
Understanding Adenomyomatosis
Adenomyomatosis is characterized by an overgrowth of the gallbladder’s inner lining, leading to wall thickening. This overgrowth forms small pockets or diverticula within the muscle layer, known as Rokitansky-Aschoff sinuses. These sinuses can trap bile, cholesterol crystals, or even small stones. While the exact cause remains unclear, chronic inflammation has been suggested as a contributing factor.
This condition is classified as a hyperplastic cholecystosis, an increase in the number of cells in the gallbladder wall. It can manifest as localized thickening, a circumferential overgrowth forming an hourglass shape, or diffuse involvement of the entire gallbladder. Adenomyomatosis is a common finding, observed in approximately 1% to 9% of gallbladder specimens removed during surgery. It is often diagnosed in individuals in their 50s.
Assessing the Risks
Adenomyomatosis is generally not considered dangerous and is a benign condition. It typically does not lead to cancer. While some older studies suggested a precancerous link, current understanding largely views it as a benign alteration.
However, adenomyomatosis can sometimes cause symptoms that resemble those of gallstones or inflammation. These can include right upper quadrant abdominal pain, nausea, or intolerance to fatty foods. Symptoms may arise if bile or crystals become trapped within the Rokitansky-Aschoff sinuses, leading to irritation or inflammation. Its appearance on imaging can sometimes be similar to that of gallbladder cancer, which can pose a diagnostic challenge. In such cases, further evaluation is necessary to distinguish between the two conditions.
Management and Treatment Approaches
The management of adenomyomatosis depends largely on whether it is causing symptoms. For asymptomatic individuals, specific treatment may not be required. In these cases, watchful waiting and periodic monitoring with imaging, such as ultrasound, is often recommended to observe for any changes.
If adenomyomatosis causes persistent or bothersome symptoms, or if there is difficulty differentiating it from gallbladder cancer on imaging, surgical removal of the gallbladder, known as a cholecystectomy, is the primary treatment option. This procedure is similar to that performed for gallstones and effectively addresses the symptoms. Laparoscopic cholecystectomy, a minimally invasive approach, is commonly preferred due to its faster recovery times. In some instances, temporary symptom relief might be achieved with pain medication or dietary modifications, such as avoiding fatty foods.
Long-Term Outlook
The long-term outlook for individuals diagnosed with adenomyomatosis is generally favorable. For those whose condition is managed through observation, many continue to remain asymptomatic without the need for intervention. The benign nature of adenomyomatosis means it typically does not progress to more serious conditions.
When cholecystectomy is performed for symptomatic adenomyomatosis, the procedure is considered curative. Patients usually experience resolution of their symptoms after surgery. The gallbladder is not considered an essential organ, and individuals can lead a normal, active life following its removal. While some dietary adjustments may be advised immediately after surgery, most people can return to their regular diet over time.