LAYERED GALLBLADDER: CAUSES, CHARACTERISTICS, TREATMENT - MEDICINE - 2025

A kinked gallbladder is a condition whose main characteristic is that the gallbladder has an abnormal or different shape than usual. Within this definition, changes in size, known as hypo or hyperplasia, are excluded.

The gallbladder is a pyriform excretory organ, located on the visceral surface of the liver. Its function is to serve as a reservoir for bile, which is produced by the liver. During the digestion of fats, the gallbladder contracts and expels bile through the common bile duct towards the duodenum, where it acts on the food bolus.

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Variations in the shape of the gallbladder are not so uncommon and often go unnoticed. They are sometimes diagnosed as an occasional finding during abdominal examination for other causes. The origin of the kinking is not known with certainty, but genetic causes and complications of other diseases appear to be involved.

The symptoms are very varied and can behave acutely or chronically. This condition affects both children and adults, without discrimination by gender. Treatment, which can be medical or surgical, will depend on the severity of the symptoms and the associated pathologies.

Causes

The etiology of this condition has not been exactly established. For many years it was believed that it was an exclusive disease of the elderly and that it was a consequence of some diseases typical of age. However, this hypothesis was abandoned when several cases appeared in children.

It is currently believed that there is a congenital factor that contributes to gallbladder malformation. That would explain the cases that occur in early childhood. Adhesions or flanges are also associated that form as a result of inflammatory processes or infections of the gallbladder itself.

In adults, the layered gallbladder is associated with complications from certain chronic diseases. There have been cases of anatomical gallbladder malformations in diabetics, probably associated with previous asymptomatic infections. Some deforming skeletal pathologies have been associated with gallbladder malformations.

characteristics

Anatomical features

From an anatomical point of view, the gallbladder is described as a neck, a body, and a fundus. The same is done with any sack-shaped viscera.

When we speak of a layered vesicle, the area of ​​the same that is affected is the fundus. This is reported in the imaging studies carried out.

The basic characteristic of kink is the appearance of a fold in the imaginary line that separates the body from the vesicular fundus. Because of this, the bottom bends over the body, as the forearm bends over the arm when the elbow is flexed. This is the appearance of the gallbladder and hence the name "kink."

Clinical features

It is estimated that 4% of the world population has a kinked gallbladder. However, this condition alone does not cause any disease. In fact, most of the reported cases are due to occasional surgical findings or evidenced in autopsies of patients who died from other causes.

Although the angled gallbladder has no clinical significance of its own, its presence has been associated with various abdominal pathologies. Chronic allithiasic cholecystitis - inflammation of the gallbladder without the presence of stones inside it - is one of these diseases related to kinking of the gallbladder.

Patients with chronic allithiasic cholecystitis present with diffuse abdominal pain, loss of appetite, nausea, and vomiting. Since this clinical picture is very nonspecific, imaging evidence is needed to reach a diagnosis, such as thickening of the vesicular walls or kinking of the same.

Other clinical pictures

Research studies have shown statistically significant evidence that people with an angled gallbladder are at higher risk of acute cholecystitis. This may be because the kink folds are the ideal site for the retention of cell debris and bacteria.

Slowed gallbladder emptying has also been described. This picture appears especially after eating copious foods or diets rich in fat.

In some occasions the kink is confused with tumors or calculi, for which the imaging studies must be precise and carried out by experts.

Diagnosis

The angled gallbladder can be identified by ultrasonography, computed axial tomography, cholecystography, and nuclear magnetic resonance. Abdominal ultrasound is not very accurate and can lead to confusion with liver tumors or gallstones.

Nuclear magnetic resonance is the study par excellence to determine the presence of a bent vesicle. In case of contraindication, the ideal is computerized axial tomography. Both studies make it possible to easily differentiate the kinking of tumors or liver masses, as well as stones inside the gallbladder.

Treatment

The layered gallbladder has no clinical importance of its own, therefore it has no specific treatment. However, the diseases associated with its presence do require it. The management of these pathologies can be done with pharmacological or surgical therapy, depending on the severity of the case.

Chronic allithiasic cholecystitis is initially managed conservatively. Treatment with prokinetic, antispasmodic and digestive drugs is indicated, accompanied by dietary modifications.

If there is no clinical improvement, then the possibility of removing the gallbladder through open cholecystectomy or laparoscopy is considered.

The usual treatment for acute cholecystitis is cholecystectomy. When the symptoms of gallbladder inflammation are accompanied by fever and clinical signs of infection or sepsis, antibiotics should be indicated as soon as the patient is admitted. Treatment is complemented with analgesics, antispasmodics and a low-fat diet.

Cholecystectomy

Removal of the gallbladder is known as a cholecystectomy. This procedure can be carried out in a traditional way, through a right subcostal oblique incision in the abdominal wall (Murphy's line) or laparoscopically, introducing thin trocars into the abdomen through which the surgical instruments pass.

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This last route is the most used today. The procedure is less invasive, the marks or scars are smaller, the pain is milder, and the recovery is faster.

Laparoscopic cholecystectomy is one of the most performed surgeries worldwide and different techniques have been described to make it even less traumatic.

References

1. Barraza, Patricio; Paredes, Gonzalo and Rojas Eduardo (1976). Angled or malformed gallbladder. Chilean Journal of Pediatrics, 47 (2): 139-142.
2. Hassan, Ashfaq et al. (2013). Surgical significance of variations in anatomy in the biliary region. International Journal of Research in Medical Sciences, 1 (3): 183-187.
3. Carbajo, Miguel A. and collaborators (1999). Congenital Malformations of the Gallbladder and Cystic Duct Diagnosed by Laparoscopy: High Surgical Risk. Journal of the Society of Laparoendoscopic Surgeons, 3 (4): 319-321.
4. Rajguru, Jaba et al. (2012). Variations in the external morphology of gallbladder. Journal of the Anatomical Society of India, 61 (1): 9-12.
5. Van Kamp, Marie-Janne S. et al. (2013). To Phrygian Cap. Case Reports in Gastroenterology, 7 (2): 347-351.
6. Reyes Cardero, Jorge and Jiménez Carrazana, Agustín (1995). Chronic Alithiasic Cholecystitis: A Diagnosis of Exclusion? Cuban Journal of Surgery, 34 (1).