Patients with the inflammatory condition known as porcelain gallbladder are at increased risk for the development of gallbladder cancer. For this reason, the disease should be treated with surgery to remove the gallbladder. The type of surgery used for removal can vary based on the clinical presentation of the patient's disease.
The mainstay of treatment for this condition is a cholesytectomy, which is a surgery performed to take out the gallbladder. The reason why surgery is required in patients with this condition is that it is frequently associated with gallbladder cancer. As many as a third of patients diagnosed with porcelain gallbladder have coexisting gallbladder cancer. The other two-thirds are at an increased risk for developing gallbladder cancer, as compared to the general population.
In cases of porcelain gallbladder, how the surgical removal is done depends on the pattern of disease present. The condition is classified based on the appearance of the gallbladder on ultrasound, an imaging technique that uses sound waves to reveal the features of structures inside the body. Ultrasound is a useful way to diagnose this condition because it easily detects the calcification located in the gallbladder wall. Three patterns, types I-III, have been identified based on their ultrasonographic characteristics.
Types II and III porcelain gallbladder are considered the most dangerous types. Early surgery is recommended for patients falling into these two categories. Most times, an open cholecystecomy is required. What this means is that the surgeon performing the operation will make a 5-7 inch (about 13-18 centimeter) incision, or cut, in the upper part of the abdomen on the right side. Making a large incision allows the surgeon to see the gallbladder more clearly, and remove it with greater precision.
In contrast to types II and II, type I porcelain gallbladder is less severe and sometimes can be treated with a less invasive surgery. Often a laparoscopic cholecystecomy suffices in these patients. With this procedure, three small incisions are made in the abdomen. A camera probe is inserted through one incision, and surgical instruments are used to access the gallbladder through the other two incisions. The benefits of a laparoscopic cholecystectomy are a shorter recovery time and a decreased risk of bleeding and infection.
Porcelain gallbladders are most often diagnosed incidentally. In other words, imaging studies done for other reasons detect the abnormality. Imaging techniques such as abdominal computed tomography (CT) scans, abdominal x-rays, or abdominal ultrasounds easily display the diseased gallbladder. The condition is called “porcelain” gallbladder because of the calcifications present in its wall. Often the condition develops from chronic inflammation of the gallbladder, such as from chronic cholecystitis.