S3489 Porcelain Gallbladder Stable After 52 Months of Conservative Management

Introduction: Porcelain gallbladder, characterized by calcification of the gallbladder wall, is a rare condition often associated with an increased risk of gallbladder carcinoma. It is most often asymptomatic and found incidentally. This case describes the incidental discovery of diffuse mural calcification of the gallbladder in a 60-year-old man with multiple comorbidities. Case Description/Methods: A 60-year-old man with a medical history of nonischemic cardiomyopathy, chronic diarrhea, psoriasis, type II diabetes, and blindness was undergoing a computed tomography intravenous pyelogram for nephrolithiasis. Incidentally, the scan revealed diffuse mural calcification of the gallbladder, consistent with a porcelain gallbladder. The patient was asymptomatic, with no signs of biliary colic, cholecystitis, biliary dyskinesia, choledocholithiasis, or pancreatitis. At the time of the discovery, the patient had no abdominal symptoms attributable to the biliary system, which remained consistent during follow-up. A repeat computed tomography scan 52 months later demonstrated a porcelain gallbladder of similar size, with no evidence of new symptoms or complications. Given the patient's advanced age and multiple comorbidities, the decision was made to manage the condition conservatively. He was advised against surgical resection due to the potential risks outweighing the benefits in this context. Discussion: Porcelain gallbladder may be asymptomatic in 82% of patients. Despite the theoretical risk of gallbladder carcinoma, recent studies suggest that this risk may be lower than initially thought. Intramural calcification has lower malignant potential, and prophylactic cholecystectomy may be avoided, especially in asymptomatic patients with significant perioperative risks. This case highlights the incidental finding of porcelain gallbladder in a patient with multiple comorbidities and underscores the importance of individualized decision-making regarding management. In cases where patients are asymptomatic and at high surgical risk, conservative management may be a reasonable approach.