Disease Description (Causes and Symptoms)
- Disease name: Adenomyomatosis of the gallbladder
- Causes and pathophysiology: Hyperplasia of the gallbladder mucosa (epithelium) accompanied by hyperplasia of the gallbladder muscular layer causes the mucosa to invaginate into the muscle layer, resulting in cystic dilatation and thickening of the muscle layer. Rokitansky–Aschoff sinuses (RAS, small cystic spaces formed by invagination of the mucosa into the muscle layer) are commonly observed (found in approximately 90% of cases). The cause is unclear, but increased intragallbladder pressure (due to gallstones, impaired gallbladder emptying, congenital obstruction, etc.) may be associated.
- Clinical symptoms: Most patients are asymptomatic. When symptoms occur, they may include upper abdominal pain (colicky pain or right upper quadrant pain) and dyspepsia-like symptoms; if gallstones are present, symptoms associated with cholelithiasis may occur. Some patients with acalculous adenomyomatosis may also complain of pain.
- Clinical significance by type: The focal (segmental) type is reported to require greater caution in differentiating it from cancer.
Treatment Methods
- Diagnosis and evaluation (tests for treatment decisions)
- Ultrasound (abdominal ultrasound): Suspected based on intramural cystic spaces, comet-tail artifact (or mucosal echoes), etc.
- Abdominal CT: Helpful for evaluating the structure.
- Endoscopic ultrasound (EUS), MRI, and MRCP: Used to identify RAS and cystic structures more accurately and to rule out findings suspicious for cancer (such as wall irregularity and infiltrative lesions).
- Conservative treatment
- Asymptomatic patients: Observation (regular symptom checks and follow-up imaging when necessary).
- Mild symptoms: Pain control (analgesics) and additional evaluation if symptoms worsen.
- Medication
- There are no medications that specifically alter the underlying cause. Symptomatic treatment (analgesics and, if necessary, antibiotics) is provided for pain or acute inflammation.
- Procedures/Surgery
- Cholecystectomy (usually laparoscopic cholecystectomy) may be considered when abdominal pain persists, gallbladder cancer cannot be ruled out, or accompanying gallstones cause symptoms.
- Surgery tends to be recommended when there is a segmental lesion or findings suspicious for malignancy on imaging.
- Lifestyle management
- Although there is no clear method of prevention, general recommendations include maintaining a healthy weight and eating regular meals to lower the risk of gallstones.
- Precautions (including the risk of complications)
- The course is benign in most cases, but differentiation from cancer is occasionally necessary (especially in the segmental form). Cholecystitis, gallstones, and gallbladder dysfunction may occur concurrently.
Checklist Before an Outpatient Visit (Including Example Questions)
- Items to prepare
- A list of medications currently being taken (prescription drugs, over-the-counter drugs, and supplements)
- Past medical history (particularly gallbladder disease, gallstones, abdominal surgery, and liver disease)
- Previous test results (abdominal ultrasound, CT, MRI, etc.) — if possible, bring imaging CDs or reports
- Symptom diary: location, severity, and duration of pain; relationship to meals; accompanying symptoms (fever, vomiting, etc.)
- Precautions before testing
- Fasting (6–8 hours) may be required for most ultrasound examinations (confirm the hospital’s instructions).
- Example questions (to write down in advance)
- What findings were seen on my recent abdominal ultrasound? (RAS, intramural cysts, etc.)
- When should I come back if my symptoms worsen?
Examples of General Questions to Ask the Doctor
- Could this disease progress to cancer? How often should follow-up be performed?
- What are the criteria for surgery (symptoms and imaging findings)?
- Are there any precautions regarding my current medications or lifestyle habits?
- How should I manage the pain when it occurs (medication, diet, etc.)?
Examples of Disease-Specific Questions
- Were Rokitansky–Aschoff sinuses or comet-tail findings seen on my imaging (ultrasound/CT/MRI)? Is it a segmental (focal) form or a diffuse (generalized) form?
- If imaging suggests malignant findings (irregularity of the gallbladder wall, surrounding infiltration, etc.), what additional tests would you recommend (endoscopic ultrasound, MRI, early surgery, etc.)?