Contracted or Vanishing Gallbladder: A Case Report

A contracted or "vanishing" gallbladder is a condition characterized by severe atrophy or fibrosis of the gallbladder, often resulting from chronic inflammation, recurrent cholecystitis, gallstone disease, or metabolic disorders such as diabetes and chronic alcohol use. The etiopathogenesis involves progressive fibrosis due to persistent biliary obstruction, chronic infection, or impaired blood flow, particularly in patients with liver cirrhosis. While the exact incidence remains unclear, it is more prevalent in individuals with long-standing hepatobiliary diseases or metabolic syndromes. Common symptoms include severe right upper quadrant pain, jaundice, nausea, vomiting, and signs of obstructive jaundice, such as dark urine and pale stools. Diagnostic investigations typically involve ultrasound, contrast-enhanced computed tomography (CECT), magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde cholangiopancreatography (ERCP) to assess biliary obstruction, liver pathology, and gallbladder morphology. Treatment requires a multidisciplinary approach, including initial ERCP for biliary decompression, followed by surgical intervention (laparoscopic or open cholecystectomy), with conversion to open surgery often necessary due to dense adhesions and fibrosis. Postoperative care focuses on managing comorbidities, preventing complications, and long-term monitoring of liver health. This case report presents the challenging management of a 34-year-old male with a history of diabetes mellitus, chronic alcohol use, and liver cirrhosis, who presented with severe right upper quadrant pain, jaundice, and ascites. Initial evaluation revealed cholangitis, calculous cholecystitis with choledocholithiasis, and imaging findings consistent with liver cirrhosis. The patient underwent ERCP for biliary stenting and sludge extraction, followed by an attempted laparoscopic cholecystectomy. Intraoperatively, dense adhesions and fibrosis obscured the gallbladder, confirming a contracted or "vanishing" gallbladder, prompting conversion to an open procedure. The case highlights the diagnostic complexities of contracted gallbladders, which often result from chronic inflammation, fibrosis, or metabolic disorders. Preoperative imaging, including ultrasound and MRCP, played a critical role in identifying biliary obstruction and liver pathology. However, intraoperative findings necessitated adaptive surgical decision-making to mitigate risks such as bile duct injury or hemorrhage. The patient's multiple comorbidities further complicated management, emphasizing the need for a multidisciplinary approach involving gastroenterologists, surgeons, and hepatologists. Postoperative recovery was closely monitored for complications, including infection and bile leaks. The patient was discharged with follow-up care focusing on liver health, diabetes management, and alcohol cessation. This report underscores the importance of thorough preoperative assessment, flexibility in surgical technique, and collaborative care in optimizing outcomes for patients with complex gallbladder pathology. Future research should explore long-term outcomes and improved imaging techniques to enhance surgical planning for such challenging cases.