Acute
acalculous cholecystitis is characterized by acute
inflammation of the gallbladder in the absence of stones, usually occurring in elderly and
critically ill patients with
atherosclerosis, recent surgery or
trauma, or hemodynamic instability. Patients may present with only unexplained
fever,
leukocytosis, and
hyperamylasemia without right upper quadrant tenderness. If untreated, rapid progression to
gangrene and perforation occurs. Surgical
cholecystectomy and
cholecystostomy provide the most definitive treatment although recent studies indicate success with percutaneous or endoscopic
cholecystostomy. Cholesterolosis and adenomyomatosis of the gallbladder are usually clinically silent and incidental findings at the time of
cholecystectomy. Cholesterolosis is characterized by mucosal villous
hyperplasia with excessive accumulation of
cholesterol esters within epithelial macrophages. Usually clinically silent, the condition rarely is associated with biliary symptoms or idiopathic
pancreatitis and cannot reliably be detected by ultrasonography. Adenomyomatosis describes an acquired, hyperplastic lesion of the gallbladder characterized by excessive proliferation of surface epithelium with invaginations into a thickened muscularis propria. Ultrasonography may reveal a thickened gallbladder wall with intramural
diverticula. Adenomyomatosis may portend a higher risk of gallbladder
malignancy. Most cases of cholesterolosis and adenomyomatosis identified by imaging require no specific treatment. Gallbladder
polyps include all mucosal projections into the gallbladder lumen and include
cholesterol polyps,
adenomyomas, inflammatory
polyps,
adenomas, and other miscellaneous
polyps. Most
polyps are nonneoplastic and rarely cause symptoms.
Cholecystectomy is advocated for
polyps greater than 10 mm in size because of increased risk of adenomatous or carcinomatous features.