A CASE OF PORCELAIN GALLBLADDER

Abstract

The purpose of this report is to demonstrate porcelain gallbladder in sixty-seven years old lady and also analized the composition of gallstones and the structure of gallbladder wall. Calcified shadow with oval shape was observed in abdominal plane X ray film. Porcelain gallbladder with common bile duct stone was diagnosed and operation was perfomed. The gallbladder wall was felt as stonelike hard. The gallbladder contained shallow yellowish mixed cholesterol stone and adhered with liver tightly by inflammation change. The color of common bile duct stone was black. The same analysis pattern was obtained from gallbladder and common bile duct stones by infrared absorption spectrophotometory. It contained cholesterol over 95% and calcified components was mainly calcium phosphate and calcium bilirubinate. Gallbaldder wall could not be analyzed because of impure substances. Porcelain gallbladder of our case was caused by chronic inflammatory changes and stasis of bile subsequence to longstanding cystic duct obstruction. We consider that common bile duct stone had existed for long period without any symptom, therefore cystic and common bile duct stone had similar composition, which led to the obstruction of cystic duct. We recommend the early operation of porcelain gallbladder because of high risk evidence of gallbladder carcinoma in the clinical course.