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Patients with the inflammatory condition known as porcelain gallbladder are at increased risk for the development of gallbladder cancer. For this reason, the disease should be treated with surgery to remove the gallbladder. The type of surgery used for removal can vary based on the clinical presentation of the patient's disease.
The mainstay of treatment for this condition is a cholesytectomy, which is a surgery performed to take out the gallbladder. The reason why surgery is required in patients with this condition is that it is frequently associated with gallbladder cancer. As many as a third of patients diagnosed with porcelain gallbladder have coexisting gallbladder cancer. The other two-thirds are at an increased risk for developing gallbladder cancer, as compared to the general population.
In cases of porcelain gallbladder, how the surgical removal is done depends on the pattern of disease present. The condition is classified based on the appearance of the gallbladder on ultrasound, an imaging technique that uses sound waves to reveal the features of structures inside the body. Ultrasound is a useful way to diagnose this condition because it easily detects the calcification located in the gallbladder wall. Three patterns, types I-III, have been identified based on their ultrasonographic characteristics.
Types II and III porcelain gallbladder are considered the most dangerous types. Early surgery is recommended for patients falling into these two categories. Most times, an open cholecystecomy is required. What this means is that the surgeon performing the operation will make a 5-7 inch (about 13-18 centimeter) incision, or cut, in the upper part of the abdomen on the right side. Making a large incision allows the surgeon to see the gallbladder more clearly, and remove it with greater precision.
In contrast to types II and II, type I porcelain gallbladder is less severe and sometimes can be treated with a less invasive surgery. Often a laparoscopic cholecystecomy suffices in these patients. With this procedure, three small incisions are made in the abdomen. A camera probe is inserted through one incision, and surgical instruments are used to access the gallbladder through the other two incisions. The benefits of a laparoscopic cholecystectomy are a shorter recovery time and a decreased risk of bleeding and infection.
Porcelain gallbladders are most often diagnosed incidentally. In other words, imaging studies done for other reasons detect the abnormality. Imaging techniques such as abdominal computed tomography (CT) scans, abdominal x-rays, or abdominal ultrasounds easily display the diseased gallbladder. The condition is called “porcelain” gallbladder because of the calcifications present in its wall. Often the condition develops from chronic inflammation of the gallbladder, such as from chronic cholecystitis.
I had a serious gallbladder issues that were dismissed by docs as IBS for many years (even in the E.R., no scan for me). Then, after several extreme attacks, it was found that my gallbladder was badly infected and my liver levels were way off.
One of my final attacks blew a branch of the hepatic artery and I lost 5 units of blood into my belly and out my backside (while doctors did nothing, and would not listen to me tell them I was bleeding). The bleeding was discovered during my E.R. admission and by me at home on the loo. Had it not been for my very thick blood (polycythemia and high levels of fibrin) I would
have bled to death.
In my surgery (open procedure), my gallbladder basically exploded in pus and stones. It was larger that a football and irregularly thickened with polyps (tested negative for cancer). It could not be removed due to extreme inflation (everything was glued to everything else). All they could do was remove all stones and infection, make it a bit smaller, put in a drain tube, and hope.
During my two and a half years of follow-ups, I asked about having it removed (it still hurt a lot all of the time) and the surgeon said if it were his gallbladder he would not let anyone near it with a knife. He considered it be inoperable. I could not get a second opinion. Docs in Australia will not overrule other docs; it is like a club of ego and they are easily offended, to the point they would prefer a patient die rather than have another surgeon "show them up" by saving them.
After two and a half years of regular CTs and ultrasounds (every six months they did a CT and an ultrasound) there was no visible change. Then I did have a change in one six month period. They could not see into my gallbladder at all. No calculi were visible. The thickness of the gallbladder was a mystery. All they could see was one large shadow.
The surgeon said I have porcelain gallbladder and it is inoperable. It still hurts constantly. From time to time I have minor attacks (passing gravel I suspect, but no big ones). I had one of those today. I have pain 24/7 and in the nine years since that surgery they have changes the rules and nobody gets pain meds for anything chronic -- not ever.
I do not (and did not) eat a fatty diet. I eat an all organic diet low in fat as fat has always given me the runs, no alcohol, etc. I now also have fibromyalgia, and Chronic Fatigue Syndrome, chronic myofascial pain syndrome and neuropathic pain problems as well as bone pain (I do not make Vitamin D and cannot absorb it well.)
I want this to stop and I can't have chemo if this goes to cancer as I now also have developed very bad multiple chemical sensitivity (how I wish it were not a real thing, but my huge blister scars from small pesticide exposures say otherwise).