Management of Gallbladder Adenomyomatosis

Diagnosis and Evaluation

Ultrasound (US) is the imaging modality of choice for diagnosing gallbladder adenomyomatosis, with high-frequency probes enabling identification of characteristic Rokitansky-Aschoff sinuses (RAS), and if differentiation between tumefactive sludge and adenomyomatosis is challenging, short-interval follow-up US within 1-2 months with optimized technique is recommended 1
Contrast-enhanced ultrasound (CEUS) can help distinguish vascular lesions from sludge and should be considered if uncertainty persists after follow-up US 1
MRI should be considered if CEUS is not available, as it can identify RAS with extremely high sensitivity 1
CT has inferior diagnostic accuracy compared to CEUS or MRI for characterizing gallbladder lesions 1

Cholecystectomy is the recommended treatment for symptomatic adenomyomatosis of the gallbladder, with laparoscopic approach being the standard of care regardless of presentation, and has a minimal surgical risk (morbidity of 2-8%) 1
The risk of bile duct injury during cholecystectomy is approximately 0.3-0.6% 1

Laparoscopic cholecystectomy is safe during pregnancy regardless of trimester, but ideally performed in the second trimester 2
For patients presenting late in the third trimester, postponing surgical intervention until delivery may be reasonable if it doesn't pose risk to maternal or fetal health 2

The Society of Radiologists in Ultrasound (SRU) consensus suggests that extended follow-up of gallbladder lesions beyond 3 years is not productive 1
This timeframe is sufficient to identify the vast majority of polyp-associated malignancies 1