Giant gallbladder mucocele with interparietal abdominal wall extension: a case report

Abstract

Gallbladder mucocele (hydrops) is an uncommon consequence of prolonged cystic duct obstruction, usually caused by an impacted gallstone at the gallbladder neck or cystic duct. Giant gallbladder mucoceles are rare, and extension into the abdominal wall with interparietal displacement has seldom been described. This case is reported in accordance with the CARE (CAse REport) guidelines. A 73 year old woman presented with a four-week history of a progressively enlarging right upper quadrant mass associated with mild abdominal discomfort. She had no fever, jaundice, or biochemical evidence of biliary obstruction. Contrast-enhanced computed tomography demonstrated a markedly distended gallbladder measuring approximately 15×12×13 cm, with an impacted gallbladder-neck calculus and anterior extension into the abdominal wall between the rectus sheath layers. Open cholecystectomy was performed because of significant anatomical distortion and concern regarding iatrogenic rupture and safe biliary dissection. Intraoperatively, the gallbladder was massively distended, densely adherent to the abdominal wall, and displaced between the anterior and posterior rectus sheaths. Controlled decompression released approximately 800 mL of mucinous fluid, allowing improved operative exposure. Intraoperative cholangiography demonstrated normal biliary anatomy without choledocholithiasis. Histopathological examination confirmed chronic cholecystitis with obstruction-related gallbladder distension, Rokitansky–Aschoff sinus formation, fibrosis, and chronic inflammatory changes, without evidence of dysplasia or malignancy. This case describes an unusual presentation of giant gallbladder mucocele mimicking an abdominal wall mass. Cross-sectional imaging was essential for diagnosis and operative planning, while controlled decompression, intraoperative cholangiography, and open cholecystectomy facilitated safe management in the setting of severe anatomical distortion.