A Case of Traumatic Neuroma of the Gallbladder

Abstract

We experienced a case of traumatic neuroma incidentally noted in the gallbladder resected for choledo cholithiasis. Ultra-sonography, computed tomography, and intravenous cholangiography indicated stones in the common bile duct in an 85-year-old female and operation was performed. Many stones were found din the dilated common bile duct. The gallbladder was atrophic and its wall thickened and hardend. Microscopically, thickening of the gallbladder wall was due mainly to nodular proliferation of peripheral nerve fascicles. A diagnosis of traumatic neuroma was made over. Traumatic neuroma in the gallbladder is very rare and a review of the literature disclosed only two cases of it. This paper presents the third case of traumatic neuroma of the gallbladder, with some discussion of its symptoms and pathogenesis.

Traumatic (or amputation) neuroma

“…[1][2][3][4][5][6][7] There is consensus that inflammation is present in the majority of cases, which is supported by our case. Our findings suggest that the severity of inflammation may be important, and that significant tissue damage, such as in perforation and fistula formation, may be important stimuli for neuroma formation.…”

“…Neuromatous change occurs mainly in the cystic duct remnant, 1 with primary gall bladder occurrence highly unusual, having been described only three times in the literature. [2][3][4] The unique operative findings and histology of this case provides new evidence on the aetiology of traumatic neuroma, supporting current theories on its pathogenesis.A 66-year-old man presented with epigastric pain and jaundice. On examination, he was afebrile with mild epigastric tenderness and no palpable masses.…”

Traumatic (or amputation) neuroma

“…Proposed aetiological mechanisms have included ischaemia, chronic inflammation, pressure (including nerve enclosure during vessel ligation), infection, foreign bodies or stimulation from bile and cholesterol 1−7 . There is consensus that inflammation is present in the majority of cases, which is supported by our case.…”

“…Traumatic (or amputation) neuroma is a rare post‐cholecystectomy phenomenon whose pathogenesis remains unknown. Neuromatous change occurs mainly in the cystic duct remnant 1 , with primary gall bladder occurrence highly unusual, having been described only three times in the literature 2−4 . The unique operative findings and histology of this case provides new evidence on the aetiology of traumatic neuroma, supporting current theories on its pathogenesis.…”