Honeycomb Gallbladder; A Rare Sonographic Congenital Anomaly

    Known as a multiseptated gallbladder (MSG), where septa are seen along the loom of the gallbladder in a sonographic view. According to the research that exists at the moment, it has been observed in pediatric patients as well as adults of both genders due to in-pouching of the gallbladder wall to produce septa, harbouring muscle fibres, which is most likely the cause of congenital honeycomb gallbladder. It is a rare abnormality in which only 150 cases have been reported worldwide (Terkawi et al., 2021). The gallbladder may develop more quickly than the surrounding structures and wrinkle as a result of a shortage of room, according to some theories, these wrinkles have the potential to cause gallbladder invasions that eventually combine with intraepithelial tissue (Hsieh et al., 2021).

                                                        Figure 1: Short axis view of MSG (Ghey et al., 2022)

Symptoms of MSG:

    While persistent general abdomen discomfort or pain in the upper right quadrant (87.2%) and nausea are the most common complaints made by patients when they check into the hospital, some individuals do not report any pain at all and even have normal lab findings. While not exhibiting symptoms, it is nevertheless important to pay attention to it (Terkawi et al., 2021).

Diagnosis Using Ultrasound:

Ultrasound is the most suitable technique for diagnosis. Performing this type of examination is done while fasting for around 6 to 8 hours to have the optimal view of the gallbladder. On the day of the exam, the patient lies down in a supine or left lateral decubitus position. Then the sonographer uses convex (2–8 MHz) and linear (3–13 MHz) transducers to take longitudinal and cross-sectional views of the organ in addition to systematic scanning around the subcostal (slightly below the costal margin) and intercostal (in-between the ribs) regions. Evaluation of the anatomy and contents is necessary. This includes the form, size, wall thickness, regularity, and textural patterns of the gallbladder walls. Multiple images can be obtained while examining the right upper quadrant abdominal region to observe the structure of the septa and other associated abnormalities including possible developing stones in the lumen, thickening of the gallbladder walls, or even enlargements. Figure 2 shows a sonographic image of an MSG case, the gallbladder expands to its typical size while being multiseptated, especially in the area closest to the gallbladder neck. This odd developmental defect known as a "honeycomb" appearance is consistent within the gallbladder (Murray, 2023). 

                                                           Figure 2: Oblique view of MSG (Murray, 2023)

Other diagnostic modalities:

Magnetic resonance cholangiopancreatography (MRCP) and computed tomography can also be used to have a more detailed look at the multiseptated gallbladder and its surrounding anomalies.

Method of Treatment:

Painkillers can be given to handle the symptoms, however, the current optimal treatment of choice is the complete removal of the gallbladder through a cholecystectomy procedure, after that, patient discomfort in the abdominal region resolves.

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References

Aydin, R., Bilgici, M. C., Polat, A. V., Aslan, K., & Kalayci, A. G. (2013). Honeycomb gallbladder. Pediatric Emergency Care, 29(12), 1276-1277. https://doi.org/10.1097/pec.0000000000000030

Cocco, G., Basilico, R., Delli Pizzi, A., Cocco, N., Boccatonda, A., D’Ardes, D., Fabiani, S., Anzoletti, N., D’Alessandro, P., Vallone, G., Cipollone, F., & Schiavone, C. (2021). Gallbladder polyps ultrasound: What the sonographer needs to know. Journal of Ultrasound, 24(2), 131-142. https://doi.org/10.1007/s40477-021-00563-1

Ghei, R., Perice, L., & Odashima, K. (2022). Incidental diagnosis of honeycomb gallbladder on point-of-care ultrasound. Cureus. https://doi.org/10.7759/cureus.32650

Hsieh, Y., Hsieh, Y. L., Wang, N., Wu, P., & Weng, S. (2021). Multiseptate gallbladder. Medicine, 100(49), e27992. https://doi.org/10.1097/md.0000000000027992

Murray, M. (2023). Honeycomb gallbladder. Case study [image]. https://doi.org/10.53347/rID-160125

Sasaki, M., Tokunaga, Y., & Minami, N. (2004). The honeycomb gallbladder: A new category of acquired pseudo-multiseptate gallbladder. Journal of Hepato-Biliary-Pancreatic Surgery, 11(5), 375-378. https://doi.org/10.1007/s00534-004-0909-4

Terkawi, R. S., Qutob, D., & Hendaus, M. A. (2021). Understanding multiseptated gallbladder: A systematic analysis with a case report. JGH Open, 5(9), 988-996. https://doi.org/10.1002/jgh3.12621