Laparoscopic Cholecystectomy for Entirely Calcified Porcelain Gallbladder: Challenges, Management, and Literature Review

Abstract

Commonly referred to as a "porcelain gallbladder (PGB)," gallbladder calcification is usually asymptomatic. It is observed that chronic inflammation of the gallbladder can occur as a result of another underlying condition, specifically gallstone disease. In the past, there was a belief that PGB had a correlation with gallbladder cancer, with an incidence rate of 30%. However, recent studies have indicated that the rate is only 5%-22%. Patients diagnosed with PGB, who are deemed to be at an elevated risk of developing cancer may undergo prophylactic cholecystectomies. However, recent research indicates that a subset of these patients may potentially avoid this surgical intervention. As a result of the increased risk of gallbladder cancer, and the difficulty of holding and retracting the gallbladder, laparoscopic cholecystectomy was not often recommended for patients with PGBs in the past. However, with the advancement of technology laparoscopy is now a choice for such difficult cases. Here we report a case of PGB in a 55-year-old female patient who complained of intermittent pain in the right upper abdomen with vaginal discharge. She was successfully managed laparoscopically.

Keywords: Chronic cholecystitis; gallstone diseases; laparoscopic prophylactic cholecystectomy; porcelain gallbladder.

Figure 1

CT scan of abdomen showing a calcified rim of gallbladder in relation to Liver, depicted by red arrow

Figure 2

(a) Completely covered gallbladder by dense adhesions that pose a difficulty during dissection, depicted by a red arrow (b) Cystic duct, cystic artery, and lymph node of the Lund, depicted by green, red, and black arrows, respectively

Figure 3

Excised specimen of porcelain gallbladder showing calcified wall and inspissated bile in the lumen without stones