Adenomyomatosis of the Gall-bladder

Abstract

Adenomyomatosis is a hyperplastic condition of the epithelial and muscular elements of the gall-bladder wall. It is also known under many other names but that used here is preferred as it is descriptive and is noncommital as far as aetiology is concerned. The condition is not uncommon but for various reasons has been rather neglected in the past. It is thought to predispose to stone formation and cholecystitis but may be found without either. It is probably a degenerative condition, the incidence increasing with advancing age. There may be associated cholesterosis. The lesions are of three main types: generalised, segmental and fundal. The radiological features of these are described. The main diagnostic points are collections of contrast medium in the dilated Rokitansky-Aschoff sinuses around the main gall-bladder shadow, strictures, septa, kinks and filling defects. The condition may be diagnosed even when Rokitansky-Aschoff sinuses are not visualised. Concentration of opaque medium and contraction after a fatty meal are usually good or excessive unless severe infection has supervened. The radiologist must impress on his clinical colleagues that this condition may cause symptoms and it should not be dismissed as just an interesting curiosity in a “normally functioning gall-bladder”. It is suggested that the term “Phrygian cap” should be abandoned in favour of “congenital septum”. “Phrygian cap” has been applied indiscriminately in the past to septate or kinked gall-bladders due to other than congenital malformations. It is stressed that congenital deformities of the gall-bladder are rare and accordingly adenomyomatosis should be excluded before a congenital anomaly is diagnosed. The main distinguishing features of congenital septa, postural kinks and adenomyomatous strictures are summarised. This paper is based on the study of 38 cases of adenomyomatosis, 34 of which have been found in a series of 1,200 consecutive routine cholecystograms, an incidence of approximately 3 per cent. The youngest case in this series was 29 years old and the sex ratio 11 males to 27 females. Some of the material presented formed part of a demonstration at the 21st Annual Congress of the British Institute of Radiology, London, 1959.