Overview of Gallbladder Diverticula
Gallbladder diverticulum (gallbladder diverticuhun) is a pouch-like structure of the gallbladder wall that protrudes outward from the cavity. It is common at the bottom of the gallbladder, often solitary, and is associated with chronic cholecystitis and increased intracapsular pressure in the gallbladder. Diverticula are divided into congenital diverticula and acquired diverticula. Congenital diverticula are true diverticula and are very rare. Acquired diverticula, caused by gallstones or adhesion traction, are pseudodiverticula. Diverticula of the gallbladder most often occur at the base or neck of the gallbladder. Congenital diverticula may not be clinically significant, and diverticula with gallstones embedded in them may undergo ulcerative perforation.
Etiology
Congenital diverticula are rare and are often due to congenital developmental abnormalities. Acquired diverticula may be due to increased intracapsular pressure and pulling of the gallbladder as a result of a weak cystic wall produced by ulcers, gallstones, or adhesions.
Symptoms
Gallbladder diverticula can be found anywhere in the gallbladder and vary in size. It may be asymptomatic, and when complicated by diverticulitis or stones, it may present with right upper abdominal discomfort, nausea, pain, and fever, and sometimes hemorrhage and perforation leading to subhepatic abscess or diffuse peritonitis.
Examination
Clinically feasible abdominal ultrasound, CT, cholecystography and other examinations. The ultrasonographic characteristics of the gallbladder are: the shape and size of the gallbladder are normal, and the wall of the gallbladder partially protrudes outward, forming a round cystic cavity, which is connected with the gallbladder cavity, and there are often small stones or sediment echoes in the diverticulum.
Cholangiography may reveal round, pouch-like diverticula protruding from the wall of the gallbladder in the body, neck or base of the gallbladder.
Laboratory tests are usually unremarkable in the absence of complications.
Diagnosis
Diagnosis is difficult in asymptomatic cases and is often confirmed during physical examination, ultrasound or cholangiography. It should be differentiated from congenital cucurbitiform gallbladder and monk’s cap gallbladder.On radiography, the diverticulum is poorly condensed, and if in the tangential position, it is seen as a cystic diverticulum with a narrow neck attached to the gallbladder.
Treatment
When gallbladder diverticulum is asymptomatic and without complications, observation is the mainstay and no special treatment can be done. If it is complicated by stones or infection, cholecystectomy should be performed. The prognosis of this disease is good, and there is no report of carcinoma in gallbladder diverticulum so far.