What Are the Common Complications of Gallbladder Adenomyomatosis?

Gallbladder adenomyomatosis is a benign, non-inflammatory condition characterized by hyperplasia of the gallbladder wall—specifically involving both the mucosal epithelium and underlying muscularis propria—along with invagination of the mucosa into the muscle layer, forming Rokitansky–Aschoff sinuses. While often asymptomatic and incidentally detected on ultrasound or MRI, it can be associated with several clinically relevant complications.

The most common complication is biliary colic, resulting from impaired gallbladder contractility and altered bile flow dynamics due to wall thickening and sinus formation. Patients may experience recurrent right upper quadrant pain, particularly after fatty meals, mimicking symptomatic cholelithiasis.

Cholecystitis—both acute and chronic—is another well-documented complication. The structural abnormalities in adenomyomatosis predispose to bile stasis, microcalculi formation within Rokitansky–Aschoff sinuses, and subsequent inflammation. In some cases, this may progress to gangrenous or perforated cholecystitis, especially when coexisting with gallstones.

Secondary complications include choledocholithiasis and obstructive jaundice, which occur when small calculi extruded from the gallbladder migrate into and obstruct the common bile duct. Pancreatitis may also develop if impacted stones obstruct the ampulla of Vater.

Although adenomyomatosis itself is not premalignant, its imaging features—particularly focal wall thickening—can closely mimic gallbladder carcinoma. This radiologic overlap frequently leads to diagnostic uncertainty and may result in unnecessary cholecystectomy. Conversely, overlooking coexisting malignancy remains a critical concern, underscoring the importance of thorough clinical correlation, advanced imaging (e.g., contrast-enhanced MRI or endoscopic ultrasound), and histopathologic evaluation.

Rare but serious complications include gallbladder perforation, fistula formation (e.g., cholecystoenteric or cholecystobiliary), and secondary bacterial cholangitis—especially in patients with longstanding disease or immunocompromise.