ISSN: 2373-6372GHOA

Gastroenterology & Hepatology: Open Access
Case Report
Volume 2 Issue 2 - 2015
Gallbladder Polyps, Surgical Indications According to their Size and Morphology
Nelson Carrillo* and Miguel Perez Central
Department of Gastroenterology, University of Venezuela, Venezuela
Received: Febraury 1, 2015| Published: April 07, 2015
*Corresponding author: Nelson Carrillo, University of Venezuela, Libertador Avenue, Angostura Building, 7 Floor, Office 7B, Caracas, Venezuela, Tel: 58-212-7632202; Fax: 58-212-9917903; E-mail: @@
Citation: Carrillo N, Central MP (2015) Gallbladder Polyps, Surgical Indications According to their Size and Morphology.Gastroenterol Hepatol Open Access 2(2):00035. DOI: 10.15406/ghoa.2015.02.00035

Abstract

A case is presented of a 40 years old female with gallbladder polyp with an early adenocarcinoma.

Keywords: Gallbladder polyp, early gallbladder adenocarcinoma

Case

A 40 years old female patient is studied by vague symptoms, on ultrasonography of the gallbladder, vesicular polyp 15 mm in diameter was found (Figure 1). Laboratory tests, and upper Endoscopy were normal. A laparoscopic cholecystectomy was done. The pathologic examination showed a superficial mucosal adenocarcinoma without infiltration of the rest of the wall of the gallbladder. The outcome was good.
Figure 1: A large and irregular polyp, 15 mm in diameter in the gallbladder neck.

Discussion

When doing an ultrasound of the gallbladder and find unique or multiple polyps leads to the question what is the most appropriate behaviour. The gallbladder polyps are pre-malignant lesions and there are reports that the size limits 10 mm in diameter as an indication of cholecystectomy [1-5]. Ultrasound of the gallbladder is a routine study in the evaluation of patients with or without symptoms, which allows the diagnosis of these lesions in asymptomatic people. If polyps are small, with a size less than 10 mm, it is recommended periodic monitoring for every 4-6 months and measure on each test and observe its structure and shape (Figure 2&3). If increase in size or change in its morphology, should be suspected malignancy and cholecystectomy should be indicated [6], but if the size is greater than 10 mm and is irregular in the first examination , cholecystectomy should be done without waiting, because there is a 88 % chance to be a gallbladder carcinoma [7] ( Figure 4). The cancer of the gallbladder that causes symptoms is usually an advanced lesion with a poor prognosis and no curative treatment. We therefore recommend that the gallbladder polyp 10 mm or more in diameter, should undergo laparoscopic cholecystectomy and thus the local dissemination of a posible early tumor lesion is avoided.
Figure 2: Several small polyps in the gallbladder.
Figure 3: An unique and small polyp in the gallbladder, 8 mm in diameter.
Figure 4: A greater polyp in the gallbladder, 12 mm in diameter.

References

  1. Lichtenstein GR, Hanauer SB, Sandborn WJ (2009) Practice Parameters Committee of American College of Gastroenterology. Management of Crohn's disease in adults. Am J Gastroenterol 104(2): 465-483.
  2. Gisbert JP, Chaparro M, Gomollón F (2011) Common misconceptions about 5-aminosalicylates and thiopurines in inflammatory bowel disease. World J Gastroenterol 17(30): 3467-3478.
  3. Thomson AB, Gupta M, Freeman HJ (2012) Use of the tumor necrosis factor-blockers for Crohn's disease. World J Gastroenterol 18(35): 4823-4854.
  4. Adalimumab. In. Micromedex 2.0 online. Greenwood Village (CO): Thompson Reuters.
  5. Mesalamine. In. Micromedex 2.0 online. Greenwood Village (CO): Thompson Reuters. [updated 5/12/014; accessed 5/14/2014].
  6. Asacol [package insert]. Warner Chilcott Deutschland GmbH, D-64331 Weiterstadt, Germany; October 2010.
  7. Navarro VJ, Senior JR (2006) Drug-related hepatotoxicity. N Engl J Med 354 (7): 731-739.
  8. Ghabril M, Bonkovsky HL, Kum C, Davern T, Hayashi PH, et al. (2013) Liver injury from tumor necrosis factor-α antagonists: analysis of thirty-four cases. Clin Gastroenterol Hepatol 11(5): 558-564.
  9. Kaiser T, Moessner J, Patel K, McHutchison JG, Tillmann HL (2009) Life threatening liver disease during treatment with monoclonal antibodies BMJ 338: b508.
  10. Adar T, Mizrahi M, Pappo O, Scheiman-Elazary A, Shibolet O (2010) Adalimumab-induced autoimmune hepatitis. J Clin Gastroenterol 44(1): e20-e22.
  11. Grasland A, Sterpu R, Boussoukaya S, Mahe J (2012) Autoimmune hepatitis induced by adalimumab with successful switch to abatacept. Eur J Clin Pharmacol 68(5): 895-898.
  12. Hagel S, Bruns T, Theis B, Herrmann A, Stallmach A (2011) Subacute liver failure induced by adalimumab. Int J Clin Pharmacol Ther 49(1): 38-40.
  13. Frider B, Bruno A, Ponte M, Amante M (2013) Drug induced liver injury caused by adalimumab: a case report and review of the bibliography. Case Reports  Hepatol  Article ID 406901:1-3.
  14. Braun M, Fraser GM, Kunin M, Salamon F, Tur-Kaspa (1999) Mesalamine-induced granulomatous hepatitis. Am J Gastroenterol 94(7): 1973-1974.
  15. Deltenre P, Berson A, Marcellin P, Degott C, Biour M, et al. (1999) Mesalamine (5-aminosalicylic acid) induced chronic hepatitis. Gut 44(6): 886-888.
  16. Aithal GP (2011) Hepatotoxicity related to antirheumatic drugs. Nat Rev Rheumatol 7(3): 139-150.
  17. Efe C (2013) Drug induced autoimmune hepatitis and TNF-α blocking agents: Is there a real relationship. Autoimmun Rev 12(3): 337-339.
  18. Khokhar OS, Lewis JH (2010) Hepatotoxicity of agents used in the management of inflammatory bowel disease. Dig Dis 28(3): 508–518.
  19. Gladman DD, Mease PJ, Ritchlin CT, Choy EH, Sharp JT, et al. (2007) Adalimumab for long-term treatment of psoriatic arthritis: forty-eight week data from the adalimumab effectiveness in psoriatic arthritis trial. Arthritis Rheum 56(2): 476-488.
  20. Sokolove J, Strand V, Greenberg JD, Curtis JR, Kavanaugh A, et al. (2010) Risk of elevated liver enzymes associated with TNF inhibitor utilization in patients with rheumatoid arthritis. Ann Rheum Dis 69(9): 1612-1617.
  21. Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, et al. (1981) A method of estimating the probability of adverse drug reactions. Clin Pharmacol Ther 30(2): 239-245.
© 2014-2016 MedCrave Group, All rights reserved. No part of this content may be reproduced or transmitted in any form or by any means as per the standard guidelines of fair use.
Creative Commons License Open Access by MedCrave Group is licensed under a Creative Commons Attribution 4.0 International License.
Based on a work at http://medcraveonline.com
Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version | Opera |Privacy Policy