Adenomyomatosis of the gallbladder

Adenomyomatosis of the gallbladder is an entity that is being recognized increasingly, chiefly by radiologists. The pathogenesis, pathology, and indications for surgery are not well understood. This report is a study of 27 patients seen in the last 6 years, all of whom had proved histologic features. Patients ranged from 21 to 72 years of age, with a preponderance of women. Thirteen patients had no gallstones. The disease was confined to the fundus in 15 patients, to the neck in one patient, and was generalized in 11 patients. Bile cultures were obtained in the last six consecutive patients and all were negative. Histologically there was evidence of thickening of the gallbladder wall, glandular elements in the mucosa, and invagination of glands into the muscularis. The clinical, radiological, and pathologic features supported a hyperplastic and degenerative disorder which should be distinguished from cholecystitis. Associated with these morphologic changes is a dyskinesia similar to that seen in diverticular disease of the colon. Follow-up studies after cholecystectomy have shown that over 90 percent of all patients were completely relieved of symptoms. Adenomyomatosis should be identified as a distinct entity, probably of a degenerative nature. Cholecystectomy is indicated and beneficial when the symptoms suggest biliary tract diseases.