The human body is a complex web of interconnected organs, each with its own crucial role to play. The gallbladder is a small pear-shaped organ located in the right abdomen. Its main function is to store and secrete bile thereby helping the body to digest fats. You must have heard of gallstones causing discomfort, but have you heard of ‘porcelain gallbladder’?
Surprised? Don’t be! Renowned laparoscopic surgeon for Gallbladder Dr Amita Jain is here to explain all you want to know about this condition.
What is a Porcelain Gallbladder?
A porcelain gallbladder is when a gallbladder’s inner wall is encrusted with calcium. The wall becomes fragile, brittle, and bluish in colour which gives it a porcelain-like appearance. Also called calcified gallbladder or calcifying cholecystitis, porcelain gallbladder can be divided into two types based on the extent of calcification. They are:
Complete intramural calcification occurs when calcium builds up throughout the gallbladder wall, replacing its muscular layer. This leads to the shedding of the inner lining and a dense fibrous change in the entire gallbladder wall.
Selective mucosal calcification happens when only certain parts of the gallbladder wall develop calcium deposits. These deposits appear as small flecks in the inner lining of the gallbladder. This type has been associated with gallbladder cancer.
Is it Malignant?
Previously, it was thought that porcelain gallbladder was closely linked to gallbladder cancer, but new research indicates that the actual connection is weaker. Gallbladder cancer affects 6% of porcelain gallbladder patients, compared to 1% without PGB. The focus is on focal calcification, not widespread. The depth of calcification doesn’t seem tied to cancer. Common gallbladder cancer symptoms and gallbladder masses are important risk factors.
Who is at risk?
Porcelain gallbladder predominantly affects individuals over 60, with a higher incidence among females. Those with a history of gallstones, especially if present for an extended time, are at risk. Obesity, diabetes, dramatic weight loss, and fasting elevate the likelihood of developing this condition. Although often asymptomatic, it can lead to complications, including an increased risk of gallbladder cancer. Regular monitoring and, if necessary, surgical intervention are crucial for effective management.
Symptoms and Diagnosis
Porcelain gallbladder doesn’t often present with distinct symptoms, which can make diagnosis challenging. Symptoms typically include a dull pain in the right upper abdomen that usually occurs due to the consumption of fatty food. Nausea and occasional vomiting along with bloating and flatulence happens usually in the evening.
Often, porcelain gallbladder is incidentally discovered during diagnostic imaging procedures conducted for unrelated issues. Abdominal X-ray, CT scans, or ultrasound and MRI can reveal the calcification of the gallbladder walls. Lab tests are not available to specifically detect this condition. Usually, a person’s test results will fall within normal parameters.
Treatment
Individuals with total porcelain gallbladder should undergo cholecystectomy (surgical removal of the gallbladder) upon symptomatic or complicated gallbladder issues. Those with partial mucosal type may benefit from surgery even if they are asymptomatic. Prophylactic cholecystectomy offers the advantage of removing the gallbladder to prevent hidden malignancies.
Laparoscopic cholecystectomy is preferred for such patients, but gripping the gallbladder becomes tricky. Single-incision laparoscopy is cosmetically better but harder than the usual method. Patients with conditions like cirrhosis face elevated risk during cholecystectomy due to comorbidities.
Porcelain gallbladder might be a rare condition, but its potential implications are serious. While it’s not always associated with noticeable symptoms, its link to gallbladder cancer emphasizes the importance of understanding and managing this condition. As with any medical condition, early detection and appropriate management are key to maintaining optimal health.
Dr Amita Jain is a surgeon with highest degree of professional competence, precision and surgical craftsmanship. Performed all complicated general surgery procedures with in depth knowledge of invasive and few minimal invasive and onco surgical techniques. Underwent special training in trauma, executed various trauma-related complex life-saving neurosurgical procedures, reconstructed injured mangled limbs and performed vascular and reconstructive procedures with critical care.
Dr Amita Jain holds 28 plus years of rich experience in Trauma and General Laparoscopic Surgeries (including Gallbladder stone removal, appendix removal, hernia repair surgery, piles and fissure surgeries). She was the Professor Surgery of at the Army College of Medical Sciences and Base Hospital Delhi Cantt. In 1994 she was commissioned as Surgeon under the United Nations Mission in Congo. From 2020 to 2022, she worked with Bansals Hospital. Currently, Dr Amita Jain is the Senior Consultant, (Speciality: General and Laparoscopic Surgeon) at Artemis Lite Hospital, New Delhi