Dumbbell Gallbladder Diagnosed by ERCP

Abstract

A 76-year-old woman presented with a 3-year history of intermittent and worsening right upper quadrant abdominal pain. The abdominal pain was not associated with nausea or vomiting, and did not get worse with food intake. Laboratory results were normal. Abdominal computed tomography (CT) showed a 2.3 x 1.9-cm fluid-filled lesion of the biliary system consistent with a type II choledochal cyst, accessory gallbladder, or gallbladder diverticulum (Figure 1). A magnetic resonance cholangiopancreatography (MRCP) was consistent with a type II choledochal cyst ( Figure 2). Endoscopic retrograde cholangiopancreatography (ERCP) with cholangiogram confirmed gallbladder stricture (Figure 3). Subsequently, laparoscopic cholecystectomy and pathology also confirmed a gallbladder stricture (Figure 4). Postoperatively, the patient's symptoms resolved. Gallbladder strictures are rare and can be either congenital or acquired. Congenital strictures are classified as annular strictures, projection of folds of the inner lumen, or fundus strictures. Causes of acquired strictures include, intramural infections, adhesions, chronic indurative processes, or malignancy.1,2 A gallbladder stricture can often be confused for a choledochal cyst on imaging, including MRCP.3 MRCP is often the test of choice for a diagnosis of choledochal cyst because it is less invasive; however, ERCP has a higher sensitivity and should be used if imaging findings are uncertain. Sensitivity may be decreased if inflammation and severe scarring are present. 4 EUS is known to be effective for the diagnosis of small pancreatobiliary lesions, and can detect lesions as small as 1-2 mm, but there is very limited information regarding EUS for diagnosis of gallbladder strictures.

Dumbbell gallbladder cholecystitis on tc-99m diisopropyliminodiacetic acid hepatobiliary imaging

“…Gallbladder duct stricture is a rare phenomenon that can be either acquired or congenital. [ 5 ] Gallbladder strictures have also been reported to create a dumbbell-shaped gallbladder with a proximal and distal ends. [ 6 ] This altered morphologic configuration of the gallbladder can result in altered extravasation of bile from the gallbladder into the common bile duct, and likely stasis of bile in the distal end.…”