Hydrops of the gallbladder can show a variety of symptoms. Epigastric pain and discomfort in the right-upper-quadrant are common with frequent episodes of nausea and vomiting. It often develops as a secondary condition masking a more serious ailment, for example, tumors in the bile duct, enlarged surrounding organs (e.g. hepatomegaly) or lymph nodes in the vicinity of the gallbladder. It can also form as a consequence of cholelithiasis. All these possible causes lead to a reduced capability of the bile duct to evacuate the gallbladder [1]. A hydrops of the gallbladder has also been reported after long periods of total parenteral nutrition and extended use of ceftriaxone. The condition presents as a large, palpable and somewhat tender mass in the epigastric region with minimal inflammatory signs. In extreme cases, the gallbladder can extend down to the pelvis [2].

If the above mentioned key symptoms are accompanied by fever, the bile is likely to be infected and suggests acute gallbladder empyema. If a patient exhibits jaundice, it is a strong indication of a common bile duct obstruction [3].

While hydrops of the gallbladder is quite common in children, in adults, it occurs concomitantly with acute toxic hepatitis [4]. Occasionally, an enlarged gallbladder could also be a congenital anomaly [5].

• Plethora

  Consequently, it is necessary to utilize a plethora of imaging techniques in combination with laboratory studies to confirm the diagnosis. [symptoma.com]

• Abdominal Mass

  The symptoms and signs of AHGB include abdominal pain, vomiting, abdominal mass and/or tenderness. [ncbi.nlm.nih.gov]

  Palpable abdominal mass with some tenderness Symptoms may worsen with eating, particularly fatty meals. [healthhype.com]

• Biliary Colic

  If the gallbladder hydrops was formed after the first attack of biliary colic, bile admission process in the bladder and emptied his broken. [medicalformat.com]

  Dropsy of the bladder often begins with biliary colic (pain intense character in the right upper quadrant radiating to the right shoulder or scapula, often after intake of fatty and spicy foods or bumpy drive, calming after injection of morphine, pantopoda [lecheniebolezni.com]

  Treatment of biliary colic : aims to relieve pain, nausea, vomiting and anxiety. Bed rest is recommended during the painful phase. Medical treatment is addressed to uncomplicated biliary colic. [bendomd.com]

  The following features may help to distinguish an attack of biliary colic from acute cholecystitis. [sites.ualberta.ca]

• Gallbladder Enlargement

  […] duct 60 Courvoisier’s gallbladder gallbladder enlargement from obstruction at the level of the distal common bile duct. 61 Sonographic Appearance Courvoisier’s gallbladder Enlarged gallbladder Thin walls 62 causes Courvoisier’s gallbladder mass at the [easynotecards.com]

  Fig. 6. 18 Determining the dimensions of the gallbladder Enlargement of the gallbladder Large gallbladders can occur as morphologic variants ( Figs. 6.19, 6.20 ), especially in older patients and diabetics. [radiologykey.com]

• Ectopia Lentis

  Page 896 - Genetic linkage of the Marfan syndrome, ectopia lentis, and congenital contractural arachnodactyly to the fibrillin genes on chromosomes 15 and 5. N Engl J Med 1992;326:905-909. ‎ [books.google.com]

• Skin Lesion

  Henoch-Schönlein Syndrome (HSS) is characterized by the presence of purpuric skin lesions, colicky abdominal pain, renal manifestations, and arthritis. [ncbi.nlm.nih.gov]

• Dystonia

  As first seen the proband had tremor, dysarthria, dystonia and K-F ring on the cornea. After 10 months of treatment with penicillamine his transaminases normalized, the tremor, dysarthria, dystonia initially got worse and then ameliorated. [ncbi.nlm.nih.gov]

  As first seen the proband had tremor, dysarthria, dystonia and KF ring on the cornea. After 10 months of treatment with penicillamine his transaminases normalized, the tremor, dysarthria, dystonia initially got worse and then ameliorated. [eprints.ugd.edu.mk]

There is no direct laboratory test to probe for a hydrops of the gallbladder. Consequently, it is necessary to utilize a plethora of imaging techniques in combination with laboratory studies to confirm the diagnosis.

Standard laboratory tests to consider are bilirubin levels and alkaline phosphatase levels, which can be mildly elevated as a consequence of an obstructed common bile duct. Serum amylase levels can be significantly raised as a consequence of acute pancreatitis, which may impair bile duct function. A mild leukocytosis is frequently observed in patients with a hydrops of the gallbladder [6].

An abdominal X-ray procedure typically reveals a hydrops of the gallbladder as a large globular shadow in the subhepatic region. This finding is nonspecific but should only be used as a backup check. An ultrasonographic image of the right upper quadrant can show a slightly thickened gallbladder wall and pinpoint the location of possible gallstones [7]. Computed tomography is well suited to check for possible hepatic or pancreatic conditions affecting the gallbladder. Both the extended gallbladder and the thickened wall are clearly visible, while it may be difficult to localize gallstones with this method [2].

Surgically opened hydropic gallbladders exhibit clear and watery or mucoid content, a white and slightly thickened wall and sometimes accumulated gallstones near the neck of the bile duct [8]. An extraordinarily thick gallbladder wall in combination with a viscous and opaque intraluminal fluid are indicative of gallbladder empyema or pyocele [9].

• Thrombocytosis

  We report a case complicated by several unusual manifestations, including hydrops of the gallbladder and extreme thrombocytosis. [ncbi.nlm.nih.gov]

  Blood tests demonstrated non-specific inflammation with thrombocytosis, elevated aminotransferases (2-3xULN) and alkaline phosphatase (ALP), normal Gamma-glutamyltransferase (GGT) and bilirubin levels. Infectious workup was negative. [ard.bmj.com]

• Immunoglobulin A Decreased

  Intravenous immunoglobulin therapy decreases the major cardiovascular complication of the disease. [turkiyeklinikleri.com]

1. Aldagi M, Haghighat M, Dehghani SM. Gallbladder Hydrops Due to Viral Hepatitis A Infection: A Case Report. Jundishapur J Microbiol. 2015;8(1): e15779.
2. Feldman M, ed. Sleisenger and Fordtran's Gastrointestinal and Liver disease. 6th ed. Philadelphia, PA: WB Saunders Company; 1998.
3. Agrawal S, Jonnalagadda S. Gallstones, from gallbladder to gut. Management options for diverse complications. Postgrad Med. 2000;108(3):143-153.
4. Albu S, Voidazan S, Popa D. Gallbladder Hydrops Associated with an Episode of Acute Liver Toxicity in the Adult: May It Be Considered a Surgical Emergency or Not? Journal of Interdisciplinary Medicine. 2016;1(2):180-182.
5. Zong L, Chen P, Wang L, et al. A case of congenital giant gallbladder with massive hydrops mimicking celiac cyst. Oncol Lett. 2013;5(1): 226-228.
6. Rosen P, Barkin R. Emergency Medicine: Concepts and Clinical Practice. 4th ed. St. Louis, MO: Mosby-Year Book Inc; 1998.
7. Maurer K, Unsinn KM, Waltner-Romen M, et al. Segmental bowel-wall thickening on abdominal ultrasonography: an additional diagnostic sign in Kawasaki disease. Pediatr Radiol. 2008;38(9):1013-1016.
8. Mofti AB, Al-Momen A, Suleiman SI, et al. The single gallbladder stone - is it innocent?. Ann Saudi Med. 1994;14(6):471-473.
9. Vijayaraghavan R, Belagavi CS. Double gallbladder with different disease entities: a case report. J Min Access Surg. 2006;2:23-26.