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Adenomyomatosis


Presentation

  • Case presentation A 34-year-old man with no history of systemic disease presented with fever; he had lost 8 kg during the week before presentation. Physical examination revealed no significant findings.[ncbi.nlm.nih.gov]
  • Enhancing Healthcare Team Outcomes Adenomyomatosis of the gallbladder is a rare presentation but can be mistaken for several other GI tract disorders.[ncbi.nlm.nih.gov]
Asymptomatic
  • In fact, adenomyomatosis is often asymptomatic and detected incidentally.[ncbi.nlm.nih.gov]
  • Adenomyomatosis per se is usually asymptomatic. It is, however, frequently associated with chronic biliary inflammation, most commonly gallstones (25-75%), but also seen in cholesterolosis (33%) and pancreatitis 2.[radiopaedia.org]
  • The treatment for asymptomatic cases is yet to be determined. The association between gallbladder malignancy and GAM remains unclear.[ncbi.nlm.nih.gov]
Physician
  • IT IS apparent to many physicians that there exists a group of diseases of the gallbladder which require surgery for functional and anatomic disease, but where the diagnosis of cholecystitis or cholelithiasis is not substantiated by pathological examination[jamanetwork.com]
Gangrene
  • If untreated, rapid progression to gangrene and perforation may occur. Therefore, delay in surgical intervention was not recommended.[ncbi.nlm.nih.gov]
Pathologist
  • […] in Vienna, Austria and Ludwig Aschoff (1866–1942), a pathologist in Bonn, Germany. [10] [11] See also [ edit ] Cholecystectomy Strawberry gallbladder Diverticulum Hyperplasia Gallbladder References [ edit ] Ram and Midha (August 1975).[en.wikipedia.org]
Right Upper Quadrant Pain
  • Adenomyomatosis also can be associated with right upper quadrant pain.[ncbi.nlm.nih.gov]
  • upper quadrant pain (often due to gallstones) appearances (especially when focal) may be difficult to distinguish from malignancy General imaging differential considerations include: gallbladder carcinoma Phrygian cap gallbladder polyp (cholesterol polyp[radiopaedia.org]
Recurrent Abdominal Pain
  • Adenomyomatosis of the Gallbladder as a Cause of Recurrent Abdominal Pain. J. Pediatr. 2018 Nov; 202 :328-328.e1. [ PubMed : 29903530 ] 4. Pang L, Zhang Y, Wang Y, Kong J.[ncbi.nlm.nih.gov]
Dyspepsia
  • The common symptoms of pain in the right upper quadrant of the abdomen, dyspepsia, fatty food intolerance, nausea, and vomiting that have been reported in GAM cases did not appear in our patient, either.[ncbi.nlm.nih.gov]
Food Intolerance
  • The common symptoms of pain in the right upper quadrant of the abdomen, dyspepsia, fatty food intolerance, nausea, and vomiting that have been reported in GAM cases did not appear in our patient, either.[ncbi.nlm.nih.gov]
Suggestibility
  • […] characteristically curvilinear arrangement of multiple rounded hyperintense intraluminal cavities visualized on T2-weighted MR imaging and MRCP 4 hourglass configuration in annular types Nuclear medicine PET/CT Metabolic characterization with FDG PET has been suggested[radiopaedia.org]
  • Evaluation Abdominal ultrasound is the suggested diagnostic imaging test when a patient presents with right upper quadrant pain. Sometimes the ultrasound findings are characteristic of adenomyomatosis, and a confident diagnosis can be made.[ncbi.nlm.nih.gov]
  • Recently, several investigators suggested that MRI is the most accurate diagnostic technique for GAM characterized by the presence of Rokitansky-Aschoff sinuses. 18F-fluorodeoxyglucose positron emission tomography for GAM may reveal hot spots, which cannot[ncbi.nlm.nih.gov]

Treatment

  • Adenomyomatosis is often asymptomatic and incidentally detected, requiring no specific treatment. Adenomyomatosis also can be associated with right upper quadrant pain.[ncbi.nlm.nih.gov]
  • It is most often an incidental finding and usually requires no treatment. It may be found more often in chronically inflamed gallbladders (which are at higher risk for carcinoma), but it is not a premalignant lesion in itself 5.[radiopaedia.org]
  • Thus far, cholecystectomy has not been considered as a standard treatment for GAM. However, in symptomatic GAM patients, cholecystectomy is indicated [ 3, 6 ]. The treatment for asymptomatic cases is yet to be determined.[ncbi.nlm.nih.gov]

Prognosis

  • Prognosis Apart from the right upper quadrant abdominal pain that some patients experience, this is a benign condition and carries a good prognosis. Not all patients are symptomatic.[ncbi.nlm.nih.gov]
  • […] medicine PET/CT Metabolic characterization with FDG PET has been suggested as a useful adjunct in problematic cases 4, but there have also been cases with increased uptake in areas of adenomyomatosis, leading to false positive results 6 Treatment and prognosis[radiopaedia.org]

Etiology

  • The hypothesis of chronic inflammation as the etiology of adenomyomatosis is supported by the fact that patients are most frequently diagnosed in their 50s.[ncbi.nlm.nih.gov]

Epidemiology

  • Since patients are most frequently diagnosed in their 50s, the idea of chronic inflammation as the etiology seems plausible. [3] [4] Epidemiology Adenomyomatosis has been found in 1% to 8.7% of cholecystectomy specimens.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology [ edit ] Adenomyomatosis of the gallbladder as seen on ultrasound [2] Non-contrast abdominal ultrasound and contrast-enhanced ultrasound (CEUS) of adenomyomatosis of the gallbladder: [3] a The fundus of the gallbladder wall was thickened[en.wikipedia.org]
  • There is no known race predilection. [5] Pathophysiology Hyperplasia of the gallbladder wall is seen, with characteristic Rokitansky-Aschoff sinuses. Calculi and cholesterol crystals form within the sinuses.[ncbi.nlm.nih.gov]

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