Segmental adenomyomatosis of the gallbladder predisposes to cholecystolithiasis.
OBJECTIVE
The aim of the present study was to clarify the association between adenomyomatosis of the gallbladder and cholecystolithiasis.


METHODS
A cholecystectomy was performed for cholelithiasis or various other conditions in 1099 patients, of whom 608 had cholecystolithiasis. Adenomyomatosis of the gallbladder was classified as one of three variants: segmental, fundal, and diffuse. Segmental adenomyomatosis has an annular stricture dividing the gallbladder lumen into the "neck compartment" and the "fundal compartment". Bile lipid analysis was performed in 8 patients with segmental adenomyomatosis.


RESULTS
Adenomyomatosis of the gallbladder was observed in 156 patients (14.2%), of whom 99 had segmental adenomyomatosis, 54 had fundal adenomyomatosis, and 3 had diffuse adenomyomatosis. The prevalence of cholecystolithiasis was higher in patients with segmental adenomyomatosis (88.9%) than in those without adenomyomatosis (52.3%; P < 0.001). Gallstones were detected earlier in patients with segmental adenomyomatosis than in those without ( P < 0.001) and were located predominantly in the fundal compartment. Bile in the fundal compartment had lower concentrations of total bile acids ( P = 0.012), with an increased cholesterol saturation index ( P = 0.012), compared to bile in the neck compartment.


CONCLUSIONS
Segmental adenomyomatosis is a condition predisposing to cholecystolithiasis, probably due to the lithogenic environment in the fundal compartment. Fundal or diffuse adenomyomatosis appears to be unrelated to cholecystolithiasis.
Nishimura
Atsushi
A
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, 951-8510, Niigata, Japan.
Shirai
Yoshio
Y
Hatakeyama
Katsuyoshi
K
D018194:Adenomyoma / Q000150:complications* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001646:Bile / Q000737:chemistry; D041761:Cholecystolithiasis / Q000209:etiology*; D004108:Dilatation, Pathologic; D005260:Female; D005706:Gallbladder Neoplasms / Q000150:complications* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies