Rare gallbladder adenomyomatosis presenting as atypical cholecystitis: case report

Abstract

BackgroundGallbladder adenomyomatosis is a benign condition characterized by hyperplastic change in the gallbladder wall and overgrowth of the mucosa because of an unknown cause. Patients with gallbladder adenomyomatosis usually present with abdominal pain. However, we herein describe a case of a patient with gallbladder adenomyomatosis who did not present with abdominal pain, but with only fever.Case presentationA 34-year-old man presented to our hospital with a fever. No abdominal discomfort was declared. His physical examination showed no abnormalities. Ultrasound of the abdomen revealed thickness of the gallbladder. Acute cholecystitis was diagnosed. The fever persisted even after 1 week of antibiotic therapy. Magnetic resonance imaging of the abdomen showed gallbladder adenomyomatosis with intramural Rokitansky-Aschoff sinuses. Exploratory laparotomy with cholecystectomy was performed. The fever recovered and no residual symptoms were reported at the 3-year follow-up.ConclusionsGallbladder adenomyomatosis can present with fever as the only symptom. Although the association between gallbladder adenomyomatosis and malignancy has yet to be elucidated, previous reports have shown a strong association between gallbladder carcinoma and a subtype of gallbladder adenomyomatosis. Surgical intervention remains the first-choice treatment for patients with gallbladder adenomyomatosis.

Multidetector computed tomography diagnosis of adenomyomatosis of the gallbladder

“…The association between gallbladder adenomyomatosis and gallstones ranges from 36% to 95% (9). Chronic inflammation of the gallbladder may cause gallbladder adenomyomatosis (6,8). The histopathologic findings of our patient included chronic inflammation but not gallstones.…”

“…Only occasionally does adenomyomatosis not associated with cholelithiasis cause right upper quadrant pain. The other reported symptoms are dyspepsia, fatty food intolerance, nausea, vomiting and fever (8).…”

Diagnostic Difficulty and Strategy for Gallbladder Adenomyomatosis

“…In contrast, cholecystectomy is appropriate when there is intense pain with no explanation or when associated with gallstones. 3,4 The differential diagnosis is of extreme importance due to the possible evolution of the condition. This paper describes a case of a patient with gallbladder adenomyomatosis, identifying the indication criteria: symptoms, associated gallstones and the differential diagnosis of gallbladder neoplasm.…”

Hyperplastic Lesions and Metaplastic Changes of the Gallbladder

“…Gallbladder adenomyomatosis also occurs in the pediatric age group (Alberti et al 1998;Zani et al 2005;Akçam et al 2008). Colquhoun 1961;Katz and Rickard 1963;Fotopoulos and Crampton 1964;Seyss 1966;Bevan 1970;Heald 1970;Davies 1971;Frommhold and Lagemann 1971;McCormick and Lang 1971;Skapinker 1971;Ram and Midha 1975;Muto et al 1978;Hidalgo and Lewicki 1980;Meguid et al 1984;Kidney et al 1986;Williams et al 1986;Costa-Greco 1987;Halpert et al 1989;Kasahara et al 1992;Yang et al 1996;Chang et al 1998;Secil et al 2005;Boscak et al 2006;Dirks et al 2006;Lin et al 2011;Ray et al 2012.…”