Causes, symptoms and treatment of adenomyomatosis of the gallbladder. Adenomyomatosis of the gallbladder: symptoms and treatment in women. Text of a scientific work on the topic “Adenomyomatosis of the gallbladder.”

Adenomyomatosis of the gallbladder is a thickening of the walls of the organ, which occurs due to the benign proliferation of the muscular and mucous layers. Adenomyomatosis is usually called diverticulosis or polyposis. Thickening of the walls can be up to two centimeters; the nature of the growths can be glandular or papillary in nature. There is no inflammatory reaction, organ functions are not affected, and patients do not show any complaints for a long time. The pathological process predominantly involves the muscular and mucous membranes of the gallbladder, while the mucous membrane grows into the muscular layer, forming cavities. The outer mucosal epithelium grows into smooth muscle, forming nodes and constrictions that reduce the contractility of the gallbladder. Typically, growths are recorded in the area of the bottom of the gallbladder, but can spread over the entire surface of the organ. This pathology is extremely rarely detected on its own, since in most cases it does not manifest itself in any way. puzyr.info/adenomyomatosis/

Adenomyomatosis has been little studied by modern scientists due to its low prevalence and low percentage of diagnoses.

The modern classification of the disease is based on the prevalence of the pathological process and the histology of the growths.

The prevalence of the pathological process is distinguished:

Generalized form - characterized by a uniform distribution of changes over the entire area of the muscle membrane. Cystic cavities are recorded in the muscle layer in the area of the bottom, body and neck of the gallbladder. This form is characterized by a decrease in the contractile function of the gallbladder, which over time leads to chronic cholecystitis or gallstone disease.

Local form - it is characterized by the involvement in the process of only the muscle layer in the area of the bottom of the gallbladder. In this case, focal thickening of the muscle wall in the form of hypoplasia of no more than 2 cm is recorded.
Segmental form is an intermediate option between the generalized and local form. With the segmental variant, hyperplasia occurs in a certain area of the gallbladder, separate cystic cavities appear, or slight porosity occurs.

According to the histological picture:

With the formation of adenomas - with the development of pathology, adenomas - benign tumors from the glandular epithelium - grow on the mucous membrane. The complication is very dangerous, since adenomas often degenerate into a malignant tumor.
With the formation of papillomas - neoplasms from mucosal cells growing on a stalk. Papillomas rarely become malignant.
With the development of cystadenomas - benign neoplasms, which are cysts filled with fluid.
Adenomyosis is a pathological thickening of the epithelium of the gallbladder. It is a risk factor for the development of adenomas, polyps and cystadenomas.

The exact causes of the disease have not been established to date.

According to scientists' hypotheses, there are several conditions under which this pathology develops.

For the development of adenomyomatosis, the following conditions are necessary:

increased pressure in the organ cavity - when pressure is applied to the mucous membrane, epithelial cells are damaged, regeneration processes are launched to restore tissue integrity. If there are stones in the organ cavity, the degree of damage to the membranes increases, and due to a possible pain syndrome, a spasm of smooth muscles may occur, which will lead to an even greater increase in pressure in the gallbladder. As a result, due to numerous tissue damage and constant cell division, pathological growth of the mucous and muscle layers occurs, which leads to thickening of the walls of the gallbladder;
stagnation of bile - during stagnation, a sediment is formed in the gallbladder, the main components of which are cholesterol and bilirubin, which damage surface epithelial cells, and in severe cases, smooth muscle myocytes.

Risk factors for developing gallbladder adenomyomatosis:

In most cases, the disease occurs without any symptoms. This is explained by the absence of inflammatory changes in adenomyomatosis.

In the generalized form or with severe growth of polyps, discomfort is noted, manifested by a feeling of heaviness in the right hypochondrium, dull and aching pain in the right side of the abdomen. It is also possible for dyspeptic disorders to occur – feelings of nausea, vomiting, and a bitter taste in the mouth. If this pathology manifests itself as a complication of cholelithiasis or cholecystitis, then the clinic presents symptoms of these diseases: severe pain in the right side of the abdomen, symptoms of intoxication, stool disorders, vomiting that does not bring relief, discoloration of feces and cloudy urine. In severe cases, an attack of biliary colic may develop.

Since the disease is latent, adenomyomatosis is most often detected by chance.

Laboratory tests are not relevant, since there are no signs of inflammation in the body, and the flow of bile is not always disrupted.

The leading role in the diagnosis of this disease belongs to instrumental methods:

X-ray examination has long been considered one of the main methods for diagnosing adenomyomatosis. Today, contrast radiography for this pathology is relevant only in the later stages of the disease, since X-ray photographs can detect only gross changes in the structure of the organ that develop in the later stages of the disease.

Magnetic resonance imaging is an alternative to ultrasound. Despite all the information content of ultrasound, many clinicians prefer MRI. Using this technique, it is possible to carry out a differential diagnosis of malignant neoplasms from benign ones based on the smooth contour of the latter. Another advantage of MRI is the ability to identify another characteristic sign of adenomyomatosis - the presence in the image of a “pearl necklace”, which is a sequential collection of polyps surrounding the organ.
Ultrasound examination is the most informative in making a diagnosis, as it allows you to visualize all internal changes in real time. Using ultrasound, it is possible to diagnose concomitant pathologies such as cholelithiasis or cholecystitis. There are several main signs of adenomyomatosis during ultrasound. The first is thickening of the organ wall. (The wall of the gallbladder can thicken by 1-2 cm or more; thickening can cover the entire organ, which indicates a generalized form, or cover individual areas - with a segmental form. If a segmental form is detected, thickening can be recorded in the fundus, body or cervix gallbladder. It is important to note that with thickening in the area of the bottom of the gallbladder, it is possible to suspect a transition to a malignant tumor. Deformation in the body or neck area is one of the characteristic signs of adenomyomatosis and is called the “hourglass” or “dumbbell” syndrome). The next sign is dilated Rokitansky-Aschoff sinuses, which are cavities filled with bile, microliths or flakes. Another sign is cysts - formations that are cavities filled with exudate.
Endoscopic retrograde cholangiopancreatography - when a contrast agent is injected into the common hepatic duct, defective filling of the gallbladder is observed.
Sometimes, when performing surgical interventions on the gallbladder due to cholelithiasis or cholecystitis, clinicians discover this pathology by chance.

The gallbladder is a hollow organ that is responsible for storing bile. Its examination using ultrasound is included in the mandatory set of tests for suspected diseases of the digestive tract. This includes measuring the wall thickness and assessing its condition. Thus, thickening of the gallbladder wall is a sign of its inflammation or deformation in any of the pathologies of the biliary system. This phenomenon cannot be the basis for making a final diagnosis - this will require additional diagnostic methods (blood tests, ultrasound of other organs, other studies as indicated).

The structure of the gallbladder wall

The organ is a pear-shaped bladder. Its structure consists of a wall and a cavity. The lining of the gallbladder is strong and elastic, which allows it to stretch when fluid accumulates. It consists of several layers, each of which performs its own function:

mucous (internal) - ensures the absorption of fluid, secretes enzymes and thick mucus to protect tissues from the aggressive contents of the organ;
muscular (middle) - when it contracts, bile is released into the bile ducts, contains a sphincter to regulate bile secretion processes;
serous (external) - present on all internal organs, also performs a protective function.

REFERENCE! Normally, the wall thickness should be up to 3 mm. An increase in this parameter to 4 mm or more indicates possible pathologies. It is uniform, without thickening and signs of inflammation. Its condition is determined by ultrasound with the obligatory determination of all measurements.

What does thickening of the organ wall indicate?

Hardening of the gallbladder walls is not a disease, but a symptom of various diseases. By their nature, the changes may differ, and it is important to determine the mechanism of development of the pathology. The wall of the organ can thicken for several main reasons, including:

proliferation of dense connective tissue that forms a scar;
an increase in the volume of the mucous membrane of the gallbladder;
inflammatory reactions and swelling;
fat deposits;
tumors and tumor-like formations;
anomalies of the structure and deformation of the organ.

These pathological processes underlie a number of diseases of the gallbladder and bile ducts. They can be diagnosed by ultrasound based on characteristic clinical signs, and the final diagnosis is made based on the results of an examination of the abdominal organs and blood tests.

Cholecystitis

The most common gallbladder disease is cholecystitis, or inflammation of its walls. It can be acute or chronic. In the second case, it occurs with alternating periods of remission and exacerbation. In the acute phase of inflammation, thickening of the wall is associated with its swelling, and in advanced cases - with the growth of fibrous tissue in the thickness of the muscularis propria. There are also two main forms of cholecystitis:

calculous - develops with the formation of stones;
non-calculous - has any other origin.

Signs of thickening of the walls of the gallbladder have diagnostic value in conjunction with the study of its contents. Bile is normally liquid, without foreign particles or impurities.

One of the most dangerous phenomena, which is accompanied by acute pain syndrome, is cholelithiasis with blockage of the bile ducts.

Cholelithiasis

Poor diet, an abundance of animal fats in the diet, metabolic disorders - these factors cause the formation of gallstones. They can differ in shape and size, in severe cases they completely occupy the organ cavity and block the lumen of the excretory ducts. These formations injure the mucous membrane with their edges, which leads to inflammatory processes, swelling and the growth of scar tissue.

Gallstone disease (GSD) is a common disease among people of any gender and age. The main reason why stones appear is the pathology of cholesterol metabolism. It is from this substance that most stones are formed. In some cases, they can be treated with medication, but more often, elective surgery to remove the gallbladder is performed.

Cholesterosis

The disease develops due to a violation of fat metabolism. This means that various glycerides, including cholesterol, accumulate and are deposited on the inner surface of the organ. In this regard, the wall thickens unevenly, becomes weak and inelastic. The mechanisms of muscle contraction are also disrupted, and the gallbladder is visualized on the monitor with symptoms of bile stagnation.

Deformations and structural anomalies of the organ

Another reason for compaction of the gallbladder is its anatomical abnormalities. They can be congenital or acquired. These include bending of the organ and the formation of adhesions. The first phenomenon can also be triggered by physical activity. If the flow of bile is not impaired, these pathologies are detected only during a routine examination and do not pose a threat to life. However, blocking the lumen of the organ and the accumulation of fluid in it with the impossibility of its free removal is a direct indication for surgery.

Neoplasms

One of the dangerous phenomena that causes thickening of the gallbladder wall is pathological growths and neoplasms. They are benign or malignant tumors, as well as tumor-like growths. Polyps are relatively safe, since they are located on a stalk and do not grow into the thickness of the wall. Adenomas (adenomyomatosis of the gallbladder) are benign and originate from glandular epithelial cells. Cancerous tumors are the most dangerous because they have a tendency to grow infiltratively (grow deep into blood vessels and tissues) and form metastases.

REFERENCE! Treatment tactics are selected taking into account the type of tumor, its location and tendency to progress. Thus, asymptomatic adenomyomatosis of the gallbladder is left without intervention with constant monitoring of the patient’s well-being.

Diseases of other organs and systems

To understand what gallbladder compaction is and what its nature is, it is important to assess the condition of all organs. This symptom may be secondary, so treatment must begin with eliminating the underlying disease. Thus, the wall of the gallbladder can be thickened due to a number of pathologies:

ascites (edema of the abdominal cavity) - among its symptoms are swelling of the abdominal organs;
liver diseases: hepatitis, fatty degeneration, cirrhosis;
heart failure is also a cause of organ swelling.

Such diseases affect the functions of all body systems. During their diagnosis, disorders of blood circulation and cardiac activity, the digestive tract and respiratory organs are determined. The damage to the gallbladder is secondary, so its swelling goes away when the patient’s condition stabilizes.

Ultrasound visualizes the condition of the gallbladder wall and its contents

Symptoms and diagnostic methods

In some cases, a thickened gallbladder wall is detected during a routine examination or during the diagnosis of concomitant diseases. If the outflow of bile is not impaired and the mucous membrane is not injured, the patient’s well-being remains unchanged. However, some diseases manifest themselves with a characteristic set of symptoms, which include:

painful sensations in the right hypochondrium (paroxysmal acute pain - a sign of gallstones);
nausea and vomiting, digestive disorders;
increased body temperature;
jaundice - occurs when there is a violation of the discharge of bile due to blockage of the ducts or a decrease in the motility of the organ.

More detailed information about the condition of the gallbladder can be obtained by ultrasound. The organ is located in the right hypochondrium and is adjacent to the liver. Its wall is uniform, without thickenings or kinks, and not compacted. X-ray using a contrast agent is also an informative diagnostic method.

Treatment regimen

The course of treatment is selected individually, depending on the specific diagnosis and general condition of the patient. It necessarily includes taking medications and recommendations regarding nutrition and lifestyle. In some cases, surgery may be necessary.

Diet and lifestyle

Proper nutrition is necessary to restore gallbladder function and normalize the flow of bile. The muscular layer of the organ reacts to specific receptors and begins to contract only when food enters the stomach. To ensure that bile does not stagnate in the cavity of the bladder, and its wall remains elastic, it is useful to follow a number of recommendations:

eat small portions at least 5-6 times a day;
exclude animal fats (a source of bad cholesterol, from which stones are formed);
eat food raw or cook it by boiling or steaming;
balance the diet as much as possible in terms of the amount of proteins, fats and carbohydrates;
Drinking plenty of fluids during the day prevents bile from thickening.

IMPORTANT! A healthy diet is a fundamental requirement for any treatment regimen. Overeating and excessive consumption of prohibited foods can be the cause of another attack of cholelithiasis or cholecystitis.

Drug treatment

Pharmaceutical drugs can be of synthetic or natural origin. Medicines that are prescribed for diseases of the gallbladder belong to different pharmacological groups. They act in combination, eliminating both the causes and symptoms of the disease:

antibiotics - destroy bacterial infection and prevent its proliferation in the organ cavity;
choleretic drugs - contraindicated for cholelithiasis;
anti-inflammatory drugs;
antispasmodics (according to indications).

To dissolve stones, tablets based on cholic acids are used. They participate in fat metabolism with cholesterol, which is found in stones. Gradually they become soft and decrease in size. Treatment is long-term (at least 2 years) and is not always effective.

Folk remedies

Diseases of the liver and biliary system can be treated with herbal preparations. They have an anti-inflammatory effect, improve bile flow and strengthen the immune system. Decoctions and infusions based on tansy, celandine, centaury and other herbs will be useful. You can also take decoctions of corn silk, milk thistle, sage and freshly squeezed fruit and vegetable juices.

Surgical intervention

Surgery is prescribed if it is impossible to restore the function of the gallbladder. Thus, indications for its removal may include stones that are not amenable to drug treatment, anomalies and deformations of the organ (kinks, constrictions). Surgical intervention is also necessary for adenomyosis of the gallbladder, polyps and other neoplasms prone to malignancy. After removal of the organ, a person can gradually return to their normal lifestyle - the recovery period will take no more than 1-2 months.

Gallbladder diseases can be diagnosed using ultrasound. All of them are manifested by thickening of the organ wall, but have their own characteristics. Treatment is prescribed individually; in most cases, correcting the diet and taking medications is sufficient.

Video on the topic

Symptoms of adenomyomatosis of the gallbladder are mild, and most often signs of changes in the mucous and muscle layers are detected during an ultrasound of the abdominal cavity.

Gallbladder disease, which is characterized by benign growth of its walls, is considered a rather rare pathology. This formation affects all layers of the walls of the organ and is up to 2 centimeters in size. Adenomyomatosis of the gallbladder is also called adenoma or diverticular disease. The growth can be glandular or papillary and is not an inflammatory process. The muscle tissue thickens, diverticula form, and all layers of the organ are affected.

The disease most often occurs in adults; it is rarely diagnosed in children. Nowadays, patients with adenomyomatosis are identified much more often - diagnostic methods have improved and pathology is detected in the early stages. The disease is divided into localized, segmental and diffuse forms. Adenomas, papillomas, and cystoadenomas are a type of the disease.

During the development of diverticular disease, the muscle tissue and mucous membrane undergo changes, and minor cystic changes are observed. The pathological process is localized in one place at the bottom of the organ or along the wall of the entire bladder.

In most cases, there are no symptoms of the disease, but sometimes pain and slight discomfort may appear in the gall area.

The main signs that can be seen on ultrasound are a pronounced contraction of the walls of the organ and their significant thickening.

There is proliferation (proliferation) of the upper layer of the epithelium of the mucous membrane and invagination (invasion) into the muscle layer. Then cavities form inside the walls, nodes and constrictions at the bottom of the organ. During diagnosis, depressions on the mucous membrane are visible, which are called Rokitansky-Aschoff sinuses. Due to the fact that the walls become inflamed and there are diverticula, muscle tissue is gradually destroyed, which affects the functioning of the gallbladder.

Modern diagnostic methods

The main method of examination is ultrasound diagnostics. Today, ultrasound allows us to examine the patient in more detail and identify changes in the early stages of the disease. Adenomas are almost always not detected until surgery. Wall thickening up to 1 cm and polyps are difficult to diagnose because they are difficult to see. In this case, ultrasound helps to clarify the number of polyps in the organ.

Before the use of ultrasound, cholecystography was used, when the cavities were filled with a contrast agent. This method made it possible to see the filled space and possible changes in it. The Rokitansky-Aschoff sinuses were dilated, and various defects were visible in the gallbladder using cholecystography. In addition to ultrasound, in recent years they have increasingly used modern and accurate ones.

Possible reasons

The factors influencing the formation of wall thickening have not yet been fully studied. Often the cause is various congenital pathologies of the bladder. Adenomatosis is considered a benign formation, but the walls of the organ change their structure, thicken, and cystic cavities appear. The disease has not been fully studied, and its occurrence in half of the cases is associated with cholelithiasis. In women, this pathology is more common.

Clinical signs

The disease is practically asymptomatic, sometimes an inflammatory process begins, which is detected by ultrasound diagnostics. Mild pain can only be in the right hypochondrium and not in all cases. Acute pain appears with the development of cholecystolithiasis, when. Dilation of the sinuses is a sign of disease, as well as. The growth can be single or multiple, glandular or papillary. The bottom of the bladder may thicken, cavities or diverticula may form, and the porosity of the organ increases.

Modern treatment

Treatment methods depend on the course of the disease, the number and size of polyps and nodes in the bladder. Adenomyosis is often classified as a precancerous disease. Surgery is not prescribed in all cases, but patients with adenomyomatosis should be observed by a surgeon or gastroenterologist. Sometimes even single formations larger than 15 mm become the reason for a thorough examination of the patient and removal of the organ, despite the fact that such formations are benign.

If the disease occurs without symptoms, no special therapy is performed.

Adenocarcinoma is considered a malignant form of gallbladder pathology - cell mutation occurs in the neoplasm against the background of concomitant inflammatory processes. Treatment necessarily includes cholecystectomy (surgery to remove the gallbladder). The bubble is removed completely to have a chance to stop the malignant process. It is important to consult a doctor promptly at the first painful sensation in the abdominal area, because it is not always possible to perform an operation and save a person. After removal of the gallbladder, its histological examination is carried out.

Gallbladder adenoma is a rather rare pathology, and in each patient the benign formation has different forms and symptoms. Polypoid tumor formations are removed through surgery. Timely cholecystectomy leads to complete recovery. People with diverticular disease need constant medical supervision, because sometimes the disease can become malignant.

The prevalence of adenomyomatosis is 2-5%.
Not found in children.
Adenomyomatosis of the gallbladder - idiopathic non-inflammatory non-tumor thickening of the gallbladder wall.
Adenomyomatosis is usually discovered incidentally in people aged 40-50 years.
It is equally common in men and women.
Presumably, increased intravesical pressure leads to thickening of the gallbladder wall, similar to how colonic diverticulosis leads to thickening of the inner wall of the intestine;
Classified as a type of hyperplastic cholecystosis;
Hyperplasia of the mucous membrane, thickening of the muscle layer and diverticula (enlargement of the Rokitansky-Aschoff sinus);
There are three forms of adenomyomatosis of the gallbladder: generalized adenomatosis (diffuse), segmental (ring) and localized (adenomyoma, usually in the fundus).

Which method of diagnosing adenomyomatosis of the gallbladder to choose: CT, MRI, ultrasound

Selection Methods

Ultrasound, MRCP.

Pathognomonic signs

Smooth outer contour
Small cystic intramural changes
The contractility of the bladder is preserved or increased.

The main symptoms of adenomyomatosis of the gallbladder on ultrasound

Circular or total thickening of the gallbladder wall with hypo- or hyperechoic inclusions;
The administration of cholecystokinin analogues leads to a pronounced contraction of the walls.

What will MR cholangiography images show in adenomyomatosis?

A series of diverticula in the thickened wall of the gallbladder form a “string of pearls” (generalized form);
Gallbladder in the form of “watch glasses” with circular thickening of the wall and narrowing of the lumen (segmental form);
Polypous filling defect in the bottom of the gallbladder (localized form);
After the administration of contrast, there is a pronounced accumulation of it in the mucous membrane in the early arterial phase.

Is a CT scan of the gallbladder performed for adenomyomatosis?

Circular or total thickening of the gallbladder wall
Smooth outer contour
You can define the layers of the wall.

Clinical manifestations of adenomyomatosis

Typical symptoms:

There are usually no symptoms of gallbladder adenomyomatosis.
Vague pain in the upper abdomen on the right
Sometimes persistent colic-type pain caused by muscle hypertrophy.

Adenomatosis of the gallbladder. RCP. Symptom of “string of pearls” with contrast filling of the Rokitansky-Aschoff sinuses and narrowing of the lumen of the neck of the gallbladder.