- Shyam Varadarajulu, MD
Shyam Varadarajulu, MD
- Medical Director, Center for Interventional Endoscopy
- Professor of Medicine, University of Central Florida College of Medicine
- Salam F Zakko, MD, FACP
Salam F Zakko, MD, FACP
- Executive Director, Connecticut Gastroenterology Institute
- Clinical Professor of Medicine, University of Connecticut School of Medicine
- Section Editors
- Sanjiv Chopra, MD, MACP
Sanjiv Chopra, MD, MACP
- Editor-in-Chief — Gastroenterology and Hepatology
- Section Editor — General Hepatology; Gallbladder and Biliary Tract Disease
- Professor of Medicine
- Harvard Medical School
- Senior Consultant in Hepatology
- James Tullis Firm Chief
- Beth Israel Deaconess Medical Center
- Stanley W Ashley, MD
Stanley W Ashley, MD
- Section Editor — Pancreatic and Hepatobiliary Surgery
- Chief Medical Officer and Senior Vice President for Clinical Affairs
- Brigham and Women’s Hospital
- Frank Sawyer Professor of Surgery
- Harvard Medical School
Porcelain gallbladder is associated with chronic gallbladder inflammation. Approximately 95 percent of patients have associated gallstones. Patients with a porcelain gallbladder are often asymptomatic. The diagnosis is usually made incidentally on abdominal imaging. Porcelain gallbladder is associated with an increased risk for gallbladder cancer, but the magnitude of risk appears to be small. This topic will review the epidemiology, clinical presentation, diagnosis, and management of porcelain gallbladder. Gallbladder cancer, uncomplicated gallstone disease, acalculous cholecystitis, and acute cholecystitis are discussed separately. (See "Gallbladder cancer: Epidemiology, risk factors, clinical features, and diagnosis" and "Uncomplicated gallstone disease in adults" and "Choledocholithiasis: Clinical manifestations, diagnosis, and management" and "Acalculous cholecystitis".)
TERMINOLOGY AND SUBTYPES
Porcelain gallbladder is characterized by calcification of the gallbladder wall . The term porcelain gallbladder has been used to describe the bluish discoloration and brittle consistency of the gallbladder wall associated with this condition . Porcelain gallbladder is classified based upon the extent of calcification :
●Complete intramural calcification — A continuous band of calcium infiltrates and replaces the muscular layer of the gallbladder wall. It is accompanied by sloughing of the mucosal epithelium and dense fibrosis of the entire gallbladder wall.
●Selective mucosal calcification — Calcification of the gallbladder wall is less extensive or segmental with flecks of calcium in the mucosa of the gallbladder wall.
Incidence — Porcelain gallbladder is rare and is detected in 0.06 to 0.08 percent of cholecystectomy specimens . It has a female preponderance (5:1) and is usually diagnosed in the sixth decade of life .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- OCHSNER SF, CARRERA GM. Calcification of the gallbladder ("porcelain gallbladder"). Am J Roentgenol Radium Ther Nucl Med 1963; 89:847.
- Berk RN, Armbuster TG, Saltzstein SL. Carcinoma in the porcelain gallbladder. Radiology 1973; 106:29.
- Shimizu M, Miura J, Tanaka T, et al. Porcelain gallbladder: relation between its type by ultrasound and incidence of cancer. J Clin Gastroenterol 1989; 11:471.
- Kane RA, Jacobs R, Katz J, Costello P. Porcelain gallbladder: ultrasound and CT appearance. Radiology 1984; 152:137.
- CORNELL CM, CLARKE R. Vicarious calcification involving the gallbladder. Ann Surg 1959; 149:267.
- Khan ZS, Livingston EH, Huerta S. Reassessing the need for prophylactic surgery in patients with porcelain gallbladder: case series and systematic review of the literature. Arch Surg 2011; 146:1143.
- Polk HC Jr. Carcinoma and the calcified gall bladder. Gastroenterology 1966; 50:582.
- Stephen AE, Berger DL. Carcinoma in the porcelain gallbladder: a relationship revisited. Surgery 2001; 129:699.
- Etala E. [Gallbladder cancer]. Prensa Med Argent 1967; 54:1479.
- Ashur H, Siegal B, Oland Y, Adam YG. Calcified ballbladder (porcelain gallbladder). Arch Surg 1978; 113:594.
- Kim JH, Kim WH, Yoo BM, et al. Should we perform surgical management in all patients with suspected porcelain gallbladder? Hepatogastroenterology 2009; 56:943.
- Brown KM, Geller DA. Porcelain gallbladder and risk of gallbladder cancer. Arch Surg 2011; 146:1148.
- Tomioka T, Tajima Y, Inoue K, et al. Laparoscopic cholecystectomy is a safe procedure for the treatment of porcelain gallbladder. Endoscopy 1997; 29:225.
- Kwon AH, Inui H, Matsui Y, et al. Laparoscopic cholecystectomy in patients with porcelain gallbladder based on the preoperative ultrasound findings. Hepatogastroenterology 2004; 51:950.
- Welch NT, Fitzgibbons RJ Jr, Hinder RA. Beware of the porcelain gallbladder during laparoscopic cholecystectomy. Surg Laparosc Endosc 1991; 1:202.
- Sebastian S, Araujo C, Neitlich JD, Berland LL. Managing incidental findings on abdominal and pelvic CT and MRI, Part 4: white paper of the ACR Incidental Findings Committee II on gallbladder and biliary findings. J Am Coll Radiol 2013; 10:953.
- TERMINOLOGY AND SUBTYPES
- Risk of malignancy
- CLINICAL PRESENTATION
- Clinical features
- Incidental imaging finding
- Diagnostic imaging
- - Computed tomography
- - Ultrasonography
- DIFFERENTIAL DIAGNOSIS
- Approach to management
- Conservative management
- SUMMARY AND RECOMMENDATIONS