Adenomyomatosis of the gallbladder

Adenomyomatosis of the gallbladder is characterized by hyperplasia of the mucosa and hypertrophy of the muscularis which may result from a functional obstruction to the outflow of bile. The resulting increased intracystic pressure results in invagination of the mucosa through the muscularis as intramural diverticula which may be diffuse, segmental or localized. From a series of 1,500 patients who had cholecystectomies performed during a 10 year period, 9 patients presented with symptoms indistinguishable from calculous cholecystitis and were found to have a pathologic diagnosis of adenomyomatosis without other pathologic findings. The striking feature in this group of patients was the chronicity of the symptoms before surgery (mean 7.7 years). During this time, eight of the nine patients underwent repeated radiologic investigation of the upper gastrointestinal tract for frequent symptoms. Surgical treatment led to the disappearance of symptoms in eight of the nine patients and marked improvement in the remaining patient. The presence of adenomyomatosis in a patient presenting with a symptom complex similar to that of calculous cholecystitis is an indication for cholecystectomy.