Alok Ananad MS IV
Ashley Davidoff MD
Hydrops is a chronically distended gallbladder that contains mucous or serous type bile caused by chronic obstruction most commonly as a result of a chronically impacted stone.
Structurally it is distended, and contains relatively clear or mucoid secretions. This is usually in the setting of a solitary obstruction, usually at the gallbladder neck or in the cystic duct. It is usually non-inflammatory. The wall may be relatively thick or thin. In cases of chronic or recurrent obstruction, over time reabsorption of the bile and bile salts by the gallbladder mucosa occurs. The resultant clear or mucoid liquid, sometimes called white bile, is present.
Functionally there is no large consequence to overll body functions in this disease entity.
Clinically roughtly three percent of all cases of gallbladder pathology are concomitant with hydrops fo the gallbladder. In children it may be associated with with hemorrhagic dengue or even Kawasaki’s disease. (subcutaneous lymphatic syndrome).
The patient presents with RUQ pain, usually nonicteric, and in the absence of fevers or chills. A palpapable, slightly tender gallbladder is usually noted.
Laboratory and serology will not usually be abnormal, though may approach the upper limit of normal, particularly alkaline phosphatase and white cells, depending on the degree of inflammatory involvement.
Imaging diagnosis usually depends on ultrasonography. Non tender gallbladder distension with a stone in the neck of the gallbladder would be the classiocal presentataion. Wall thickening is usually present, often due to recurrent cholecystitis. Rokitansky-Aschoff sinuses, owing to the increased luminal pressure of the gallbladder may be seen. Though this syndrome is usually considered grossly non-inflammatory, on microscopic examination, white cells maybe noted interspersed amongst the flattened mucosal cells.
Definitive treatment requires cholecystectomy.
11917.8s01 gallbladder dx cholelithiasis grosspathology Courtesy Barbara Banner MD
82335c01.8s gallbladder distendedd thick walled stone in the cystic duct pale yellow almost white fluid drainage clear fluid hydrops of the gallbladder CTscan Courtesy Ashley Davidoff MD Copyright 2008 percutaneous drainage cholecytostomy