Definition

Gallbladder hydrops is a condition in which the gallbladder enlarges due to the accumulation of clear fluid or mucus-like fluid, replacing the normally present green or brown bile. This disorder constitutes approximately 3% of all gallbladder-related conditions. Typically, gallbladder hydrops are not associated with inflammation, although inflammation in the gallbladder can still occur. The diagnosis of this condition is often incidental and may be discovered during abdominal procedures.

Cause

Gallbladder hydrops can result from various conditions, and one of the contributing factors is cholecystitis, which involves inflammation of the gallbladder. Bile, produced in the liver, circulates through bile ducts and is stored in the gallbladder. When consuming spicy or oily foods, the gallbladder is stimulated to release bile into the small intestine. However, if there is a problem with the gallbladder, this emptying process can be ineffective, leading to the formation of gallbladder stones. These stones can obstruct the bile duct, causing the accumulation of bile in the gallbladder. As a result, salts within the gallbladder are absorbed into the gallbladder tissue, giving the fluid inside a clear, semi-fluid, mucus-like consistency. The primary cause of gallbladder hydrops is often the obstruction of the bile duct, which can be attributed to factors such as tumors, congenital strictures, parasites, or pressure from liver or other tissue tumors.

Risk factors

Gallbladder hydrops share similar risk factors with cholecystitis, including factors such as rapid weight loss, stomach surgery impacting the vagus nerve essential for digestive tract movement, critical illness, diabetes, high blood fat content, and elevated calcium levels in the blood. This condition is more prevalent in women, especially those who are overweight, pregnant, or over the age of 40. Fertile women face a higher risk due to elevated estrogen levels, leading to increased cholesterol in bile and reduced gallbladder contractility. Conditions causing rapid red blood cell breakdown, such as sickle cell disease, can also contribute to the risk. Additionally, the incidence of gallbladder hydrops tends to rise with age, making it a condition associated with various factors across different demographic groups.

Symptoms

The symptoms of gallbladder hydrops typically include upper right abdominal pain, accompanied by vomiting and nausea. The pain is often felt until the umbilical area due to the enlarged size of the gallbladder. If the pain persists for six hours, there is a possibility that the condition is accompanied by acute cholecystitis. Early signs of infection include fever and shivering, and the pain often follows a history of consuming spicy or fatty foods the day before its onset. These symptoms collectively serve as indicators for healthcare professionals to assess and diagnose gallbladder hydrops and their potential complications.

Diagnosis

The diagnosis of gallbladder hydrops involves various examinations. Direct examination can be conducted to assess the spread of pain from the upper right abdominal region. Vital signs, including temperature, blood pressure, heart rate, and respiratory rate, are monitored to identify signs of fever or complications such as a ruptured gallbladder.

Laboratory examinations are essential, including a complete blood test to check for increased white blood cell count, bilirubin levels, liver enzymes, and pancreatic enzymes like amylase, which can indicate cholecystitis.

Imaging examinations play a crucial role in the diagnosis of gallbladder hydrops. Ultrasound (USG) is a primary imaging tool to identify gallbladder enlargement. The examination determines whether the fluid within the gallbladder is clear or turbid, resembling pus. 

Additional imaging, such as X-rays or CT scans of the abdomen, may be performed to exclude other diseases, although they are not specific to gallbladder hydrops. If the USG results are inconclusive, a CT scan provides a clearer image of the gallbladder, although it may not effectively show obstructions caused by gallbladder stones. Magnetic Resonance Imaging (MRI) can offer a clear image of the bile ducts and is often accompanied by endoscopy or a camera-equipped tube to visualize the entire bile duct system. These comprehensive examinations aid in confirming the diagnosis and assessing the extent of gallbladder hydrops.

Management

The primary management for gallbladder hydrops focuses on addressing the obstruction of the bile duct, typically through a laparoscopic cholecystectomy procedure. During this minimally invasive procedure, the gallbladder is removed using a device equipped with a camera at its end. The operation results in small incisions that generally heal easily. In cases where the gallbladder is too large for laparoscopic removal, an open cholecystectomy may be considered. However, this procedure involves a larger incision as it requires opening the entire abdomen to extract the gallbladder.

For patients who do not meet the requirements for surgery, an alternative procedure called cutaneous cholecystostomy may be performed. This involves inserting a small tube beneath the skin to drain fluid from the gallbladder. The movement of the tube is guided using ultrasound imaging to accurately navigate it into the gallbladder. 

Complications

Gallbladder hydrops can lead to complications such as gallbladder infection and the development of a hole in the gallbladder. The infection can transform the initially clear fluid into a pus-like substance, commonly caused by bacterial invasion. Some bacteria can produce gas, leading to air being trapped in the bile duct. A perforation in the bile duct can result in abdominal infection, known as peritonitis, which has the potential to be life-threatening. Additionally, the perforation can create a new channel into nearby structures, such as the duodenum. This can cause gallbladder stones to migrate into the small intestine, leading to obstruction. Furthermore, an enlarged gallbladder can contribute to strictures in the stomach and small intestine, making the passage of food from the stomach to the small intestine challenging. These complications highlight the importance of timely diagnosis and management of gallbladder hydrops to prevent severe consequences.

Prevention

Preventing gallbladder hydrops involves adopting measures similar to those for preventing cholecystitis. These steps include:

• Gradual weight loss: Avoiding drastic weight loss over a short period is crucial, as it can contribute to the formation of gallbladder stones. The recommended approach is a gradual weight loss of 0.5 to 1 kg per week.
• Maintaining ideal body weight: Overweight and obesity are risk factors for gallbladder stones. Maintaining an ideal body weight involves ensuring an adequate calorie intake while increasing physical activity. Engaging in physical activity 3-5 times per week with intermediate intensity for 30 minutes per day is beneficial.
• Healthy food intake: A diet high in fat and low in fiber is associated with an increased risk of gallbladder stones. To prevent this, focus on a high-fiber diet that includes fruits, vegetables, and grains. This dietary approach helps reduce the risk of gallbladder-related complications and promotes overall digestive health.

When to see a doctor?

Seek medical attention promptly if you experience persistent upper right abdominal pain. The suspicion of cholecystitis and gallbladder hydrops is heightened, especially for pregnant women, those over 40 years old, fertile women, pregnant overweight individuals, and those who have undergone drastic weight loss. Early diagnosis and treatment of these conditions can lead to a full recovery. However, if left untreated for an extended period, they can pose serious health risks, including the potential for life-threatening complications.