Hydrops of the gallbladder is a condition where the gallbladder is significantly enlarged due to excess mucus or watery fluid accumulating in its lumen. It is often associated with a gallstone-related disease but can also be the consequence of excessive fasting. Surgical treatment is required to alleviate symptoms.
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].
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].