What is Porcelain Gallbladder?
“Porcelain gallbladder” is a term used to describe a condition where the inner lining of the gallbladder is covered with calcium, making the wall hard, brittle, and sometimes blueish in color. This condition is also known as a calcified gallbladder or calcifying cholecystitis. Often, it’s discovered unintentionally during abdominal x-rays or other imaging tests because most people with porcelain gallbladder don’t show any symptoms.
The severity of this condition varies widely—ranging from one single calcium plaque attached to the inner lining of the gallbladder to being spread across the entire gallbladder wall. The latter case, where calcium fully replaces the tissue of the entire gallbladder wall, is usually what doctors refer to when they talk about porcelain gallbladder.
While porcelain gallbladder is quite rare, it was once believed to be linked to gallbladder cancer. However, current research suggests that the risk of developing cancer is low. This condition is most commonly found in older women and can sometimes be detected with a simple x-ray.
What Causes Porcelain Gallbladder?
The exact cause of hardening of the gallbladder walls (calcified gallbladder) is not known, but it is believed to be similar to the way gallstones form. Gallstones often form when bile, which the body uses to dissolve fat, remains static or does not fully drain from the gallbladder. This leftover bile can become thick, turning into sludge, then harden into stones.
Gallstones can also form due to problems which block the flow of bile, like scars of the bile duct or cancers such as pancreatic cancer. The most frequent type of gallstones is the cholesterol stones, formed when excessive cholesterol solidifies.
Another kind of gallstone is pigmented stones, which result from an excessive breakdown of red blood cells and leads to high levels of bilirubin – a waste product from broken down cells – being stored in bile. These stones are usually black in color.
The third kind of gallstones, mixed pigmented stones, are made of a mix of calcium compounds such as calcium carbonate or calcium phosphate, cholesterol, and bile. The last type of stones is primarily made up of calcium and is usually found in patients with high levels of calcium in their blood. These people often also have kidney stones.
The condition known as ‘Porcelain gallbladder’, where the gallbladder becomes hard and brittle, is believed to suggest a longstanding gallbladder problem. One theory suggests that the muscle layer of the gallbladder hardens first, leading to the loss and shedding of the now blood-deprived lining of the gallbladder.
Risk Factors and Frequency for Porcelain Gallbladder
Porcelain gallbladder, a health condition where the gallbladder wall hardens, is uncommon. It is usually seen in less than 1% of routine gallbladder removals. This condition is found more in women than men with a ratio of about 5 to 1. It also primarily occurs in people over 60 years old. It’s noteworthy that gallstones are usually present in about 95% of those with porcelain gallbladder, making their presence a significant risk factor.
Most of the time, both gallstones and porcelain gallbladders do not result in any symptoms. In the United States, gallstones are common with about 14 million women and 6 million men between the ages of 20 and 74 having them. The chance of having gallstones increases as a person ages. Being overweight can raise the likelihood of developing gallstones, especially in women, as it can lead to increase in cholesterol secretion in the bile.
On the other hand, people who experience drastic weight loss or those who fast have a higher risk of gallstones due to biliary stasis, a condition where bile is not flowing properly. There’s also a link between the formation of gallstones and hormones. Estrogen, for instance, has been observed to cause an increase in cholesterol in bile and a decrease in gallbladder contractility. Therefore, women of reproductive age and those on birth control medication that includes estrogen have twice the risk of developing gallstones as compared to men. People with chronic illnesses like diabetes are also at an increased risk due to impaired gallbladder wall contractility due to nerve damage. The long-term presence of gallstones, along with the reasons they form, seem to play a major role in the progression to gallbladder wall calcification.
Signs and Symptoms of Porcelain Gallbladder
Porcelain gallbladder often doesn’t have any noticeable symptoms. Some people, however, may have signs of chronic cholecystitis or long-term gallbladder inflammation. These signs can include a dull pain in the upper right side of the stomach that might extend to the middle of the back or the tip of the right shoulder. This pain usually occurs after eating fatty foods. Additionally, patients might feel bloated, nauseous, and might occasionally vomit. These symptoms often happen in the evening and might persist for weeks or months, gradually increasing in frequency and severity.
During a physical exam, a doctor might notice that patients experience pain when their right upper abdomen is deeply touched (a symptom known as Murphy’s sign). If the patient is quite slim or has an enlarged gallbladder, the doctor might be able to feel a hard gallbladder during the exam. Despite these symptoms, patients typically don’t feel severely ill, just uncomfortable, and their vital signs usually stay within normal limits.
- Dull pain in the upper right side of the stomach
- Pain that might extend to the middle of the back or the tip of the right shoulder
- Pain usually occurs after eating fatty foods
- Bloating
- Nausea
- Occasional vomiting
- Symptoms often happen in the evening and might persist for weeks or months
- Pain when right upper abdomen is deeply touched (Murphy’s sign)
- Possibility of feeling a hard gallbladder during a physical exam
- Discomfort rather than severe illness
- Vital signs usually stay within normal limits
Testing for Porcelain Gallbladder
This condition is often discovered unexpectedly during an x-ray test, which could be an abdominal x-ray or a CT (computed tomography) scan. An abdominal ultrasound or MRI (Magnetic Resonance Imaging) can also identify the condition. An ultrasound is often used to diagnose cases that show symptoms of cholecystitis, which is inflammation of the gallbladder. It’s also typical for lab test results to appear normal in these cases.
Treatment Options for Porcelain Gallbladder
The traditional treatment for porcelain gallbladders, which is a calcification or hardening of the gallbladder walls, is to remove the gallbladder, an operation called a cholecystectomy. In most cases, this is done using a minimally invasive procedure known as laparoscopic cholecystectomy.
In the past, a full open surgery was generally recommended to remove porcelain gallbladders, due to a belief that there was a greater risk of gallbladder cancer. However, recent findings suggest that in cases where the calcified gallbladders aren’t causing any problems and were found by accident (incidental findings), it might be better to monitor the gallbladder with regular ultrasound scans. This avoids the need for surgery unless problems develop later on. Still, many surgeons would recommend removing the gallbladder as a precaution.
What else can Porcelain Gallbladder be?
There are quite a few conditions that may seem like gallbladder disease at first glance. So, when a patient comes in with symptoms of gallbladder problems, doctors often first check for heart-related issues. Some other medical conditions that have similar symptoms include:
- Peptic ulcer disease (stomach ulcers)
- Irritable bowel syndrome (IBS)
- Inflammatory bowel disease (IBD)
- Gastroesophageal reflux disease (GERD, often simply referred to as acid reflux)
- Pulmonary embolism (a blood clot in the lungs)
- Musculoskeletal disorders (problems with the body’s muscles, joints, and bones)
In some instances, a person may have a ‘porcelain gallbladder’, but doesn’t show any symptoms. If there’s a detectable lump in the upper right part of the stomach, it might be wrongly identified as a hernia, a lipoma (a benign fat tissue lump), or various types of cancerous growths.
What to expect with Porcelain Gallbladder
Patients with noncancerous porcelain gallbladders who undergo a surgery called cholecystectomy generally have a very good chance of recovering. This chances are the same as those who have had the surgery for an inflammation of the gallbladder, also known as cholecystitis. However, a small percentage of people where gallbladder cancer has been found, unfortunately, have a far worse chance of recovery.
Much like other types of cancer, chances to completely beat the disease rely on the stage of the cancer when it is detected. Stage 1 gallbladder cancer patients have a 50% chance of surviving for at least 5 years after their diagnosis; stage 2 patients have a 28% survival rate, stages 3 and 4 have lower rates, at 8% and 2% respectively.
