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Gao Y, He D, Feng W, Yue J, Jian Z. Laparoscopic cholecystectomy for giant gallbladder: A case report. Medicine (Baltimore) 2023; 102:e35429. [PMID: 37800759 PMCID: PMC10553151 DOI: 10.1097/md.0000000000035429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/07/2023] [Indexed: 10/07/2023] Open
Abstract
RATIONALE An overdistended gallbladder is usually observed in cases of distal bile obstruction due to malignancy. The gallbladder may also become enlarged and distended during cystic duct or gallbladder neck obstruction due to gallstones. However, a grossly distended gallbladder ( > 14 cm in length) without any pathology is rare. We present the case of a 46-year-old female patient who suffered from acute right lower quadrant pain for 4 days. Initially, a liver cyst and a choledochal cyst were diagnosed by the local hospital. Then, the diagnosis of giant gallbladder (measuring approximately 20.0 cm × 7.0 cm and containing more than 30 gallbladder stones) was made by magnetic resonance cholangiopancreatography at our hospital. Finally, we successfully performed a laparoscopic cholecystectomy and the patient had an uneventful recovery. PATIENT CONCERNS A 46-year-old female patient presented with acute right lower quadrant pain lasting 4 days. At first, the abdominal pain was severe and paroxysmal, and then it subsided spontaneously. Computed tomography of the abdomen at another hospital revealed a hepatic cyst and a choledochal cyst. Come to our hospital for surgical treatment. DIAGNOSES giant gallbladder with gallstones. INTERVENTIONS Laparoscopic cholecystectomy was successfully performed in this patient after decompressing the gallbladder. OUTCOMES On the third postoperative day, the patient recovered well, and the abdominal pain resolved following the operation. At the 3-year postoperative follow-up, the patient was symptom-free, with no obvious abnormalities seen in liver function and hepatobiliary color Doppler ultrasound. LESSONS The patient was successfully treated using laparoscopic cholecystectomy. This rare case may contribute to the development of mechanisms for treating giant gallbladders.
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Affiliation(s)
- Yi Gao
- General Surgery I Department, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi Province, China
| | - Diancai He
- General Surgery I Department, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi Province, China
| | - Wenqi Feng
- General Surgery I Department, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi Province, China
| | - Jing Yue
- General Surgery I Department, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi Province, China
| | - Zhiyuan Jian
- General Surgery I Department, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi Province, China
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2
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Sapan HB, Rendy L, Tendean M, Panelewen J. Giant gallbladder case report with vascular endothelial growth factor (VEGF) serum level and mRNA expression evaluation. J Surg Case Rep 2023; 2023:rjad447. [PMID: 37583611 PMCID: PMC10425261 DOI: 10.1093/jscr/rjad447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/20/2023] [Indexed: 08/17/2023] Open
Abstract
Giant gallbladder (GGB) is a rare condition and its pathogenesis could not be explained clearly. It can result from cholelithiasis, chronic cholecystitis or neoplasm, but more rarely if created congenitally. Adequate vasculatization should support the development of this entity. A 47-year-old lady presented with a dull pain and right upper quadrant abdominal mass. A computed tomography scan showed 27 × 25 × 12 cms cystic mass expanding to the right illiac fossae, surrounded by a homogenous capsule. There were neither stones nor mass in the biliary tract and total cholecystectomy was done. Patient recovered well without signs of cholestasis 5 years postoperatively. A few cases of giant benign gall bladder have been reported in literature; however, no study has tried to investigate the mechanism of its etiology. To support the enlargement of the tissue or organ there must be some growth factors along with adequate vascularization. Vascular endothelial growth factor (VEGF) serum level and VEGF messenger ribonucleic acid (mRNA) gene expression were increased in this case. This GGB case suggests a congenital factor as its etiology. Cholecystectomy may relieve uncomfortable symptoms with good results. The incidence of GGB accompanied by increased serum VEGF levels and mRNA gene expression supports the hypothesis that VEGF plays a major role in supporting the vasculogenesis of GGBs.
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Affiliation(s)
- Heber B Sapan
- Department of Surgery, Universitas Sam Ratulangi-Kandou General Hospital, Manado, Indonesia
- Department of Surgery, Universitas Trisakti, Jakarta, Indonesia
| | - Leo Rendy
- Department of Surgery, Universitas Sam Ratulangi-Kandou General Hospital, Manado, Indonesia
| | - Michael Tendean
- Department of Surgery, Universitas Sam Ratulangi-Kandou General Hospital, Manado, Indonesia
| | - Jimmy Panelewen
- Department of Surgery, Universitas Sam Ratulangi-Kandou General Hospital, Manado, Indonesia
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3
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Zhao L, Hua Y, Zhou K. Prominent gallbladder enlargement: Kawasaki disease or other congenital or acquired gallbladder disease? A case report. J Int Med Res 2021; 49:3000605211041507. [PMID: 34496644 PMCID: PMC8442496 DOI: 10.1177/03000605211041507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Kawasaki disease (KD) is a common systemic vasculitis in childhood that can result in damage to multiple body systems. However, prominent gallbladder (GB) enlargement in the acute stage is especially rare. A 5-year-old boy was admitted to the hospital with an 8-day history of a cervical mass, 7-day history of fever, and 5-day history of abdominal pain and rash. The child was diagnosed with KD. After treatment with high-dose intravenous immunoglobulin therapy (2 g/kg), all clinical manifestations were relieved except the abdominal pain. Enhanced computed tomography showed distinct enlargement of the GB, and a congenital choledochal cyst was strongly suspected. After high-dose glucocorticoid treatment, his obviously enlarged GB returned to normal size in the subacute phase. No abnormality was found during 2 years of follow-up. Prominent GB enlargement may emerge in the acute stage of KD. The enlarged GB can return to normal size within the subacute stage by standard treatment for KD. Proper diagnosis, thorough differential diagnosis, and active anti-inflammatory treatment of KD are crucial to avoid surgery.
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Affiliation(s)
- Liang Zhao
- Department of Paediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China.,Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yimin Hua
- Department of Paediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China.,Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kaiyu Zhou
- Department of Paediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China.,Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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Bamback P, Baumgardner KC, Bartanuszova M, Nation HL, Occhialini AP. Anomalous gallbladder septum-A case report. Int J Surg Case Rep 2021; 84:106082. [PMID: 34153694 PMCID: PMC8225986 DOI: 10.1016/j.ijscr.2021.106082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Anomalies and diseases of the biliary system are common with over 20 million cases of biliary disease and an estimated 1.8 million ambulatory visits each year in the United States. Congenital anomalies of the gallbladder are rare and include complete and partial duplications, floating gallbladders, and agenesis. Septations have also been reported in the literature. Case reports have typically described these as longitudinal. Transverse septa, when reported, are associated with inflammation or cholelithiasis. Variations in the cystic duct and vasculature in the portal triad have also been well described. PRESENTATION OF CASE During the dissection of a 91-year-old female cadaver, an enlarged gallbladder with a partial transverse septum was observed. The gallbladder contained approximately 350 ml of bile, no stones, and had a partial transverse septum near the infundibulum. The hepatic, cystic, and common bile ducts were enlarged, but of normal configuration. Vascular anomalies were also present, including an accessory left hepatic artery from the left gastric artery and an anomalous origin of the right hepatic artery from the superior mesenteric artery. DISCUSSION This is the first described case of a partial transverse septum with a markedly enlarged gallbladder, dilated duct system, and vascular anomalies in a patient with no evidence of gallstones, inflammation, or scarring. CONCLUSION With the prevalence of biliary disease and frequent subsequent surgery it is essential to appreciate all anatomical variations to avoid iatrogenic injuries to these structures during surgery.
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Affiliation(s)
- P Bamback
- Long School of Medicine, University of Texas-Health at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, United States of America
| | - K C Baumgardner
- Long School of Medicine, University of Texas-Health at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, United States of America
| | - M Bartanuszova
- Department of Cell Systems and Anatomy, University of Texas-Health at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, United States of America
| | - H L Nation
- Department of Cell Systems and Anatomy, University of Texas-Health at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, United States of America
| | - A P Occhialini
- Department of Cell Systems and Anatomy, University of Texas-Health at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, United States of America.
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Bains L, Maranna H, Lal P, Kori R, Kaur D, Mallya V, Singh V. The giant resectable carcinoma of gall bladder-a case report. BMC Surg 2021; 21:133. [PMID: 33726732 PMCID: PMC7962363 DOI: 10.1186/s12893-021-01117-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/23/2021] [Indexed: 12/24/2022] Open
Abstract
Background Gall bladder cancer (GBC) is the fifth most common malignancy in the gastrointestinal system and the most common malignancy of the biliary system. GBC is a very aggressive malignancy having a 5 year survival rate of 19%. Giant Gall Bladder (GGB) is an uncommon condition that can result from cholelithiasis or chronic cholecystitis and rarely with malignancy. Case report A 65 year old lady presented with vague abdominal pain for 12 years and right abdominal lump of size 20 × 8 cms was found on examination. CT scan showed a circumferentially irregularly thickened wall (2.5 cm) of gall bladder indicative of malignancy. Per-operatively a GB of size 24 × 9 cm was noted and patient underwent radical cholecystectomy. It was surprise to find such a giant malignant GB with preserved planes. Histopathology, it was well differentiated adenocarcinoma of gall bladder of Stage II (T2a N0 M0). Discussion It is known that mucocoele of GB can attain large size, however chronic cholecystitis will lead to a shrunken gall bladder rather than an enlarged one. A malignant GB of such size and resectable is rare without any lymph node involvement or liver infiltration. Few cases of giant benign gall bladder have been reported in literature, however this appears to be the largest resectable gall bladder carcinoma reported till date as per indexed literature. Conclusion Giant GB is an uncommon finding. They are mostly benign, however malignant cases can occur. Radiological findings may suggest features of malignancy and define extent of disease. Prognosis depends on stage of disease and resectability, irrespective of size.
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Affiliation(s)
- Lovenish Bains
- Department of Surgery, Maulana Azad Medical College, New Delhi, India.
| | - Haraesh Maranna
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Pawan Lal
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Ronal Kori
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Daljit Kaur
- Department of Surgery, Maulana Azad Medical College, New Delhi, India.,Department of Transfusion Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Varuna Mallya
- Department of Surgery, Maulana Azad Medical College, New Delhi, India.,Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Veerpal Singh
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
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Mirali H, Kamaoui I, El Harroudi T, Skiker I, Serji B. Giant Gallbladder Revealed by Chronic Cholecystitis Gallstone: A Case Report and Review of the Literature. Cureus 2021; 13:e13906. [PMID: 33880262 PMCID: PMC8046698 DOI: 10.7759/cureus.13906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We report here an extremely rare case of giant gallbladder and discuss diagnostic circumstances and different ethiopathogenic theories. A 53-year-old woman presented acute right hypochondrium pain. Ultrasonography showed a huge cystic mass with gallstones and a CT scan confirmed the diagnosis of giant gallbladder. Cholecystectomy was performed. Outcomes were uneventful and histopathological examination of the specimen confirmed the presence of chronic cholecystitis. Enlargement of the gallbladder is related to biliary retention. This enlargement is favored by the slow evolution of malignant pathologies. However, some benign situations have been reported in the literature, and giant gallbladder can occur in a benign situation even if its ethiopathogeny is not so clear.
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Affiliation(s)
- Houda Mirali
- Department of Radiology, Mohammed VI University Hospital, Oujda, MAR
| | - Imane Kamaoui
- Department of Radiology, Mohammed VI University Hospital, Oujda, MAR
| | - Tijani El Harroudi
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
| | - Imane Skiker
- Department of Radiology, Mohammed VI University Hospital, Oujda, MAR
| | - Badr Serji
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
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Keshav N, Verma N, Parisi MT, Matesan M, Elojeimy S. Pictorial Summary of Congenital Gallbladder and Biliary Duct Anomalies Presentation on HIDA Imaging. Curr Probl Diagn Radiol 2021; 51:282-287. [PMID: 33483187 DOI: 10.1067/j.cpradiol.2020.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 12/17/2020] [Accepted: 12/31/2020] [Indexed: 11/22/2022]
Abstract
Hepatobiliary iminodiacetic acid (HIDA) scan is one of the principal imaging modalities for the evaluation of the gallbladder and biliary tree. Congenital biliary anomalies are rare and can be difficult to recognize on HIDA scan. They may also mimic other biliary pathology. The purpose of this article is to review the spectrum of congenital gallbladder and biliary anomalies and describe their imaging appearance on HIDA scan. In addition, the diagnostic utility of functional imaging with HIDA when evaluating biliary tract anomalies is described.
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Affiliation(s)
- Nandan Keshav
- Department of Radiology, University of New Mexico, Albuquerque, New Mexico
| | - Nupur Verma
- Department of Radiology, University of Florida, Gainesville, FL
| | - Marguerite T Parisi
- Department of Radiology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Manuela Matesan
- Department of Radiology, Division of Nuclear Medicine, University of Washington, Seattle, WA
| | - Saeed Elojeimy
- Division of Nuclear Medicine, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC.
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Elkbuli A, Meneses E, Kinslow K, McKenney M, Boneva D. Huge gangrenous gallbladder presenting as gastro-esophageal reflux disease successfully treated by laparoscopic cholecystectomy: Case report and literature review. Int J Surg Case Rep 2020; 76:315-9. [PMID: 33068857 DOI: 10.1016/j.ijscr.2020.09.193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 11/21/2022] Open
Abstract
“Giant” gallbladder development in the context of acute on chronic cholecystitis is extremely rare and may present with atypical symptoms secondary to mass effect. Current grading systems for acute cholecystitis severity do not include assessment based on size making them insufficient in predicting “giant” gallbladder surgical prognosis. Laparoscopic cholecystectomy was performed successfully despite the large gallbladder size without intraoperative/postoperative complications.
Introduction Gallbladder disease is a common surgical pathology. Gallstones can remain asymptomatic or develop into an acute cholecystitis and need for surgical intervention. Significant enlargement of the gallbladder well beyond the normal volume is rare. Such “giant” gallbladders can affect feasibility of subsequent management options. Presentation of case An 80-year-old female presented to the emergency department with a two-day history of acute on chronic gastric reflux with nausea and vomiting. On examination, she had right upper quadrant abdominal pain. CT imaging identified an enormous gallbladder creating mass effect and compression on the distal stomach. She underwent successful laparoscopic cholecystectomy and was discharged from the hospital the next day, doing well. On two-week follow up, her reflux symptoms had completely resolved and she had no complaints. Discussion Giant gallbladders are a rare entity. Our patient’s case is unique in both its occurrence as well as presentation with predominant reflux symptoms secondary to mass effect by the enlarged gallbladder. Current cholecystitis grading systems do not utilize size as a means of predicting severity and risk of operative complications or difficulty of procedure. Laparoscopic cholecystectomy was a successful approach in managing this extreme pathology. Conclusion Updated classifications systems that include size and mass effect as a predictive measure are needed to better assess surgical outcomes, especially in “giant” gallbladder disease. Despite the large size and potential mass effect on surrounding structures, laparoscopic cholecystectomy can still be attempted if no other contraindications exist.
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Jahantab MB, Salehi V, Mehrabi S, Abedini L, Yavari Barhaghtalab MJ. Cholecystomegaly: A Case Report and Review of the Literature. Case Rep Gastrointest Med 2020; 2020:8825167. [PMID: 32884849 DOI: 10.1155/2020/8825167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 02/06/2023] Open
Abstract
Chronic cholecystitis or symptomatic gallbladder is a prolonged mechanical or functional disorder of abnormal gallbladder emptying. Most of the patients have recurrent pain attacks (acute biliary colic), but when pain lasts more than 24 hours, it requires urgent surgical intervention (acute cholecystitis). The length of a fully distended gallbladder is about 7 to 10 cm. We report a case of a huge and severely inflamed gallbladder, as we have just found only a few previous case reports of the huge gallbladder in the literature. This case report and review may help to find a mechanism for the development of a giant gallbladder. The patient was a 36-year-old woman, who had been known to have a symptomatic gallstone for at least three years. The patient underwent laparotomy, and a giant 22 cm roundish severely inflamed and overdistended gallbladder with wall thickening and tight adhesion to adjacent organs was found under the right liver lobe. Femininity and diabetes seem to be risk factors for developing a huge gallbladder, and several hypotheses are encountered: (1) a long-lasting obstructed cystic duct or biliary tree, and accumulation of mucosal secretion from the gallbladder epithelium, (2) an obstructed hepatic/cystic duct junction with a stone acting like a check valve and bile trapping mechanism, and (3) gallbladder dysfunction and cholecystoparesis affecting through reduced cholecystokinin and celiac parasympathetic nerve disturbance in diabetes and diabetic autonomic neuropathy. Open cholecystectomy is the technique of choice in surgical excision of a huge gallbladder; however, laparoscopy could be performed by expert hands.
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Abstract
Giant gallbladder (GGB) is a rare condition that can result from cholelithiasis or chronic cholecystitis. Although there are no clear-cut definitions, gallbladders of >14 cm and ≥1.5 L have been regarded as GGBs. To date, most GGBs have been managed by laparotomic removal. This report describes a patient with a GGB that presented as a right iliac fossa mass. The GGB was successfully removed by mini-laparoscopic cholecystectomy. A 63-year-old woman presented with painful swelling in her right lower abdomen associated with dyspepsia and a palpable right iliac fossa mass. Computed tomography of the abdomen revealed a markedly enlarged gall bladder (19.5 x 5.4 x 5.6 cm) containing stones. Magnetic resonance cholangiopancreatography ruled out extra- and intrahepatic ductal dilatation and stones. She underwent a mini-laparoscopic cholecystectomy, and her postoperative recovery was uneventful.
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Affiliation(s)
- Joshua Fultang
- General Surgery, University Hospital Ayr/University of West of Scotland, Ayr, GBR
| | - Ugochukwu Chinaka
- General Surgery, University Hospital Ayr/University of West of Scotland, AYR, GBR
| | - Abdulmajid Ali
- General Surgery, University Hospital Ayr/University of West of Scotland, Ayr, GBR
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Affiliation(s)
- Joy C Edlin
- Department of UGI Surgery, Kingston Hospital, Kingston Upon Thames, UK
| | - Maryam Alfa-Wali
- Department of UGI Surgery, Kingston Hospital, Kingston Upon Thames, UK
| | - Amanda Bond
- Department of UGI Surgery, Kingston Hospital, Kingston Upon Thames, UK
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