An 87-year-old father had sudden onset of abdominal pain for 2 days. The pain started in the right upper abdomen with persistent distension, with paroxysmal increase, radiating to the right side of the waist; nausea and vomiting; no panic and chest tightness, no diarrhea. He came to the clinic after the pain had gradually increased over the past two days, and the pain was so extensive that it became unbearable. After consultation, physical examination revealed that the patient’s abdominal pain was mainly confined to the right side of the abdomen, with the right side of the upper middle abdomen being the most obvious, and a large intra-abdominal mass could be palpated in the right side of the upper middle abdomen, with localized pressure pain. A CT of the upper abdomen was done and the results were surprising! This gallbladder is too big! Figure 1: Picture of enlarged gallbladder As shown in Figure 1, the CT findings confirmed the diagnosis of acute calculous cholecystitis with gallbladder stones and enlarged gallbladder with acute inflammatory changes. But this gallbladder enlargement is really too big! The abdominal mass that we palpated during the physical examination was in fact the enlarged gallbladder, which had surged forward from the abdominal cavity to the anterior abdominal wall; and the CT findings further confirmed that the gallbladder was very large, occupying almost one-sixth of the abdominal cavity. There were stones inside the gallbladder. To more clearly illustrate the size of this patient’s gallbladder, its extent is marked with a red line, and the area circled by the red line in the figure below is an image illustration of the enlarged gallbladder. Figure 2: The extent of the marked gallbladder is shown This gallbladder is so large that it is rare! Perhaps you have not seen the size of a normal gallbladder, the image below is, to help you establish a contrasting concept! Figure 3: Normal size gallbladder Obviously, the reason for this gallbladder’s enlargement is caused by stones in the gallbladder. What kind of a stone should cause the gallbladder to swell to such an extent? You may think that a gallbladder stone that can cause the gallbladder to swell like this must be quite small! Is that the case? Let’s reveal the mystery. After surgical preparation and preoperative examination, a cholecystectomy was performed. A stone less than 1 cm was touched during the operation, embedded in the gallbladder duct, causing obstruction of the gallbladder duct, forming gallbladder bile infection, and the gallbladder kept accumulating fluid and expanding, forming this huge gallbladder. No way, such a small stone can hold up the gallbladder to such a large size? Right! As you can see, in patients with calculous cholecystitis, the severity of the symptoms and the change of the condition are not necessarily linearly related to the size of the stones or the number of stones! In some people, the stones are already relatively large but never show any symptoms and have no effect, and in others, the stones, although smaller, like this old man, show such serious consequences. The incidence of gallbladder stones is not low in the general population. Usually, some people have symptoms and some do not. Many people are found when they have a physical examination. Therefore, people who are found to have gallbladder stones should not ignore their harmful effects because the stones are still small, but listen to the advice of a specialist in time for accurate assessment and standardized treatment.