What Is Gallbladder Adenomyomatosis?

Gallbladder adenomyomatosis is a benign structural change that affects the wall of the gallbladder. In this condition, the inner lining of the gallbladder grows abnormally into the muscular layer beneath it, forming small pockets or outpouchings called Rokitansky-Aschoff sinuses. The gallbladder wall becomes thickened as a result.

The word sounds complicated, but the key takeaway is this: adenomyomatosis is not cancer. It is classified as a benign condition and is found fairly commonly during routine imaging.

That said, its presence does warrant proper evaluation. Depending on its pattern and any accompanying symptoms, your doctor will advise on whether monitoring or further management is appropriate.

Is Gallbladder Adenomyomatosis the Same as Gallbladder Thickening?

Gallbladder adenomyomatosis and gallbladder thickening are related but not the same thing. Gallbladder thickening is a descriptive finding on imaging. It simply means the gallbladder wall appears thicker than normal, and there are many possible reasons for this, including inflammation, infection, heart failure, liver disease, or gallstones.

Gallbladder adenomyomatosis is one specific cause of gallbladder thickening. It has a distinct appearance on ultrasound or other imaging, often with characteristic features such as small cystic spaces or comet-tail artefacts that help distinguish it from other causes of wall thickening.

So while all cases of gallbladder adenomyomatosis involve some degree of wall thickening, not all gallbladder thickening is adenomyomatosis. This is why imaging interpretation by an experienced clinician is an important step in understanding what the finding actually means.

What Causes Gallbladder Adenomyomatosis?

The exact cause is not fully understood. It is thought to develop over time as a result of increased pressure within the gallbladder, which may cause the inner lining to push into the muscular wall. Some researchers believe it may be related to chronic inflammation or changes that occur with age.

Gallbladder adenomyomatosis is more commonly found in:

1.     Women than men

2.     Adults over 40 years old

3.     Individuals who also have gallstones

It is not considered hereditary, and there are no clear dietary or lifestyle factors definitively linked to its development.

Types of Gallbladder Adenomyomatosis

Adenomyomatosis is categorised based on where the abnormal changes occur in the gallbladder.

Image credit: Cleveland Clinic

Diffuse Type: Thickening affects the entire gallbladder wall and can sometimes be harder to distinguish from other conditions on imaging.

Fundal Type: The most common form, where thickening is limited to the tip of the gallbladder and is generally the easiest to identify and monitor.

Segmental Type: Thickening forms a ring around one section of the gallbladder, sometimes giving it an hourglass shape, and requires closer monitoring due to a low but noted association with gallbladder cancer in some studies.

Symptoms of Gallbladder Adenomyomatosis and When to See a Doctor

Many people with gallbladder adenomyomatosis have no symptoms at all. It is frequently discovered incidentally during an ultrasound or scan done for another reason.

When symptoms do occur, or if you notice any of the following, consider consulting a doctor for further evaluation:

1. A dull or cramping pain in the upper right abdomen or below the right ribcage
2. Pain that worsens after eating, particularly after fatty or heavy meals
3. Nausea, vomiting, or bloating
4. Unexplained loss of appetite
5. Yellowing of the skin or whites of the eyes
6. An incidental finding of gallbladder wall thickening on a prior scan that has not yet been reviewed by a specialist

These symptoms are not unique to adenomyomatosis and can overlap with other gallbladder conditions such as gallstones or inflammation, which sometimes occur alongside it. This is why a proper assessment is important to understand what is actually causing the discomfort.

If you have already been told you have gallbladder adenomyomatosis and your symptoms are changing or worsening, it is worth seeing your doctor sooner rather than waiting for your next scheduled review.

How Is Gallbladder Adenomyomatosis Diagnosed and Treated?

Diagnosis is primarily made through imaging scans. The most common starting point is an abdominal ultrasound, which is painless, does not involve radiation, and is widely available. If the findings are unclear, further evaluation with MRI, CT imaging, or endoscopic ultrasound (EUS) may be considered to provide additional detail.

Once confirmed, treatment depends on your symptoms and scan findings.

If you have no significant symptoms, your doctor will likely recommend periodic monitoring with follow-up scans rather than immediate treatment.

If symptoms are persistent or the findings require closer attention, surgery to remove the gallbladder, known as a cholecystectomy, may be considered. In many cases, this is performed using a minimally invasive laparoscopic (keyhole) approach. Your surgeon will assess your condition and discuss the most appropriate treatment options.

The right approach is always decided on an individual basis based on your overall health, symptoms, and imaging results.

This article is intended for general educational purposes only and does not constitute medical advice. Please consult a qualified doctor for assessment and advice specific to your condition.

The Gallbladder is a small, pear-shaped organ located in the right upper abdomen under the liver. It stores bile, a fluid produced by the liver that aids fat digestion in the small intestine. There are tubes connecting the liver to the gallbladder and to the small intestine, called bile ducts. Often, a blockage in these ducts due to gallstones leads to cholecystitis.

What Is Cholecystitis?

Cholecystitis refers to the inflammation of the gallbladder.  Cholecystitis can occur either acutely or chronically:

• In acute cholecystitis, inflammation develops suddenly. While inflammation typically develops in the absence of infection, there is a risk of developing one. In acute cholecystitis, pain is often severe, prompting patients to seek emergency medical attention. Treatment typically involves medications and surgical removal of the gallbladder.
• In contrast, chronic cholecystitis is characterised by repeated pain over time. It frequently develops due to the presence of gallstones and prior attacks of acute cholecystitis. The pain is often mistaken for gastric pain and acidity as it often occurs after meals leading to delay in diagnosis.

In either case, the gallbladder’s function may be significantly impaired when it begins to fill with thick viscous fluid (called sludge) and the lining thickens, becomes scarred, or shrinks. In extreme cases, the scarring can cause calcium to be deposited in the walls of the gallbladder, causing them to harden (called a porcelain gallbladder).

If left untreated, cholecystitis can result in serious complications, including rare cases of gallbladder rupture or tissue death. Patients are strongly advised to seek medical attention if they experience symptoms of cholecystitis.

Causes of Cholecystitis

The most common cause of both acute and chronic cholecystitis is gallstones (also known as cholelithiasis). In such cases, the condition is referred to as calculous cholecystitis. Patients suffering from calculous cholecystitis may be affected depending on the type of gallstone present, such as its location or size. For instance, gallstones that completely block bile flow may result in acute cholecystitis. In contrast, gallstones that intermittently obstruct the duct may partially hinder bile flow and cause chronic cholecystitis.

That said, inflammation can also happen in the absence of gallstones in cases identified as acalculous cholecystitis. These cases are rare but more serious and usually occur in critically ill or post-surgical patients.

Other causes of cholecystitis include the presence of tumours, infection, or other bile disease or blockage due to strictures (e.g., bile duct scarring)

Cholecystitis Symptoms

Acute Cholecystitis Symptoms

Symptoms of acute cholecystitis typically involve:

• Upper abdominal pain: Pain often begins in the right upper abdomen and quickly worsens within 15 to 60 minutes, after which it may remain for 6 hours or longer. The pain may be sharp or dull and worsen when inhaling deeply or when pressure is applied. In some cases, the pain can extend to the right shoulder or back. Some people may mistake it for chest pain or a heart attack. Acute gallbladder pain is also called a gallbladder attack.
• Abdominal muscle stiffness: This can happen on the right side within a few hours of the inflammation onset.
• Nausea and vomiting
• Fever accompanied by chills.

To note, initial symptoms of acute cholecystitis in older people may not be obvious. At times, elderly patients may present with initial symptoms of a loss of appetite or fatigue, fever of unknown origin and abdominal bloating

Chronic Cholecystitis Symptoms

Pain from chronic cholecystitis tends to be less severe but comes and goes repeatedly. Discomfort is usually more apparent after a heavy meal, as eating stimulates the movement of bile. The upper right abdomen may also be tender to the touch. Many times, the patients may mistake the symptoms being related to the stomach and acidity.

When to Seek Medical Attention

Pain patterns differ between acute vs chronic cholecystitis. In acute cholecystitis, an attack may subside in 2 to 3 days and typically resolves within a week. If an attack worsens, recurs, or persists beyond a week, it may indicate a complication such as infection or gallbladder perforation. Particularly alarming signs include jaundice, dark urine, or pale-colored stools, which indicate impaired bile flow. Patients should seek immediate medical attention if any of these symptoms occur. Dial 995 to contact a nearby hospital’s Accident & Emergency (A&E) Department or visit a surgery clinic for immediate attention.

Treatment Options for Cholecystitis

Cholecystitis is frequently caused by an underlying condition (e.g., gallstones) that requires medical intervention to relieve symptoms. In general, patients will need to be hospitalised for acute or chronic cholecystitis treatment, which involves initial IV fluids and antibiotics administration. Further intervention, such as surgery, will be determined based on the type and severity of cholecystitis.

Acute Cholecystitis Treatment

In acute cholecystitis, patients who have received IV fluids and antibiotics may need to undergo gallbladder removal within 24 to 48 hours of symptom onset. Often, acute cholecystitis involves a gallstone blocking the cystic duct, which causes increased pressure inside the gallbladder and can lead to complications. To prevent serious complications, such as infection (e.g., sepsis), tissue death, or gallbladder rupture, the gallbladder needs to be removed. This is especially crucial for patients with comorbidities such as diabetes, as they are at higher risk of developing infections.

In the case of emergency surgery, patients may undergo a laparoscopic or open cholecystectomy (removal of the gallbladder). Majority of cases of acute cholecystitis are now operated using key-hole laparoscopic surgery, with the need for conversion to open surgery only in a few rare circumstances.

Chronic Cholecystitis Treatment

In chronic cholecystitis, gallbladder removal may be considered based on the patient’s condition and is usually performed when there is no active attack.

In Singapore, patients can turn to Ace Specialist Surgery and Endoscopy Clinic, which provides 24/7 support. The ACE team is prepared to promptly arrange consultations or urgent surgeries with our General Surgeon, Dr Reyaz Singaporewalla.

With over 25 years of experience in general and endocrine head and neck surgery, Dr Reyaz has undergone extensive training in minimally invasive and laparoscopic procedures. Notably, he has successfully helped many patients recover from gallbladder inflammation and is skilled in performing laparoscopic cholecystectomy.

References

1. Saiman Y, et al. Cholecystitis. In: Merck Manuals [Internet]. Merck & Co., Inc.; 2025. Available at: https://www.msdmanuals.com/home/liver-and-gallbladder-disorders/gallbladder-and-bile-duct-disorders/cholecystitis.
2. Cholecystitis (Gallbladder Inflammation): Symptoms & Treatment. Cleveland Clinic [Internet]. Available at: https://my.clevelandclinic.org/health/diseases/15265-gallbladder-swelling--inflammation-cholecystitis.

Thyroid cancer is one of the most treatable types of cancer, especially when diagnosed early. For many patients, thyroid cancer surgery plays a crucial role in successful thyroid cancer treatment, offering long-term good outcomes and a high chance of cure. Understanding how surgery works, when it is recommended, and what recovery involves can help patients make informed decisions about their care in Singapore.

What Is Thyroid Cancer Surgery?

As part of overall thyroid cancer treatment, surgery aims to remove cancerous tissue while preserving surrounding critical structures like voice nerves and parathyroid glands.

Thyroid cancer surgery also known as thyroidectomy, involves removing part or all of the thyroid gland to eliminate all cancerous tissue. The extent of thyroid removal is tailored to each individual’s condition, depending on both tumour factors such as cancer type and size. Extent of spread as well as patient factors and comorbidities. In fact, the type of thyroid cancer surgery is customised and tailored based on these criteria to achieve the best outcomes with the least morbidity.

At ACE Specialist Clinic, different surgical approaches are offered, including conventional open thyroidectomy and minimally invasive techniques such as video-assisted procedures and transaxillary endoscopic thyroidectomy (scarless in the neck approach) for different types of thyroid problems.

Why Surgery Is a Pillar of Thyroid Cancer Treatment

Surgery remains the primary definitive treatment for most forms of thyroid cancer. In many early cancer cases, it is the first step toward curing the disease and may be the only treatment modality needed.

Types of Surgical Approaches

• Total Thyroidectomy: Complete removal of the thyroid gland.
• Partial Thyroidectomy (Hemithyroidectomy): Only the tumour-bearing portion of the thyroid lobe is removed.
• Neck Lymph Node Dissection: May be performed if cancer has spread to local lymph nodes. There are different types of neck node dissection for thyroid cancer

The choice of surgery often depends on the extent of the cancer, its aggressiveness, and patient-specific clinical factors.

Can Thyroid Cancer Be Cured With Surgery?

In many cases, early thyroid cancer can be managed with surgery alone as the only required treatment, particularly when detected early. For many patients with differentiated thyroid cancers like papillary or follicular carcinoma, surgical removal can lead to long-term remission or cure.

In early-stage disease, complete removal of the thyroid gland can eliminate cancer cells, reducing the likelihood of recurrence. For locally advanced cases in which cancer has spread to lymph nodes, removal of the affected node groups further enhances treatment success along with total thyroidectomy

After surgery, additional adjuvant treatments like radioactive iodine ablation therapy and scans may be recommended based on the histopathology report to eradicate any remaining thyroid disease and check for distant metastases.

What to Expect After Thyroid Cancer Surgery

Recovery

Recovery from thyroid surgery usually involves a short hospital stay of a few days and a gradual return to normal activities. Proper wound care and follow-up appointments are essential to ensure smooth healing.

Hormone Replacement

If the entire thyroid is removed, patients will need lifelong thyroid hormone replacement therapy to maintain normal metabolism and prevent hypothyroidism.

Potential Risks and Complications

As with any surgery, thyroid cancer surgery carries some risks—though serious complications are uncommon when performed by experienced surgeons.

Possible risks include:

• Bleeding and infection
• Injury to the vocal cord nerves, which may affect the voice
• Low calcium levels due to injury to nearby parathyroid glands
• Scar formation and temporary throat discomfort
  
  

Conclusion

Thyroid cancer surgery plays a central role in curing thyroid cancer, particularly for early and intermediate stages. With the right surgical approach, expert care, and coordinated postoperative support, patients can achieve excellent outcomes and long-term health.

Thyroid cancer treatment often involves a combination of surgery, appropriate follow-up, and additional therapies when clinically indicated.

If you’ve been diagnosed with thyroid cancer or have concerns about treatment options, it’s important to consult a specialist surgeon to discuss whether surgery is the best choice for your situation.

Have you ever gone in for a routine checkup or imaging appointment, only to be told that you have gallstones or gallbladder polyps? This is not uncommon. Gallstones and gallbladder polyps that form within the gallbladder are both common incidental findings. In many cases, these abnormalities occur due to the buildup of benign cholesterol cyrstals or bile pigments. As both gallstones and gallbladder polyps can lead to clinical symptoms and complications  It is still essential to understand how to manage them and to know when to seek treatment if necessary.

What Is the Gallbladder and What Does It Do?

The gallbladder is a small, pear-shaped organ located beneath the liver. It plays a vital role in storing and releasing bile, a liquid produced by the liver to aid in fat digestion. Bile is primarily composed of cholesterol, bilirubin, and bile salts.- The gallbladder acts like a storage site of excess bile that is released into the intestines for digestion of food.

What Are Gallstones?

In some patients, the gallbladder does not function properly and the bile does not empty well. The bile pigments and cholesterol may often get concentrated into crystals which may build up over years to form one or many stones ( cholelithiasis)  within the  gallbladder. Most of the time, gallstones are found incidentally when patients go in for  Many individuals may go on to form gallstones without ever knowing they have them. existing gallstones will continue to grow as they are continually exposed to the presence of bile that will build on top of the hardened deposits.

Therefore, with gallstones, they may become a source of concern when they grow big enough to obstruct bile flow or travel up the biliary tract (network of liver-based organs and ducts) and cause a blockage. In such instances, patients may require treatment to manage their conditions.

How Gallstones Form

Gallstones tend to form when there is an imbalance in the chemicals present in bile, such as cholesterol or other salts. This imbalance, whether in excess or lack thereof, can then trigger a crystallisation process that forms gallstones.

Common Symptoms of Gallstones

Gallstones may either be asymptomatic or can cause a myriad of  symptoms and complications such as : 

• Upper abdominal pain, dyspepsia, and bloating, especially after a meal. 
• When the stones get impacted and block the flow of bile out of the gallbladder, it can present with acute constant pain in the right upper abdomen with tenderness and fever, needing emergency treatment.
• Yellowing of the skin and fever if the stone has slipped out and blocked the major bile duct.
• Severe pain in the upper abdomen radiating to the back if gallstone pancreatitis develops. This can be life threatening.
• Yellow-tinted skin and eyes.
• Dark-colored pee and light-colored poop.

What Are Gallbladder Polyps?

Unlike gallstones, gallbladder polyps are growths that appear on the inner lining of the gallbladder. Therefore, these growths are not free-floating but attached to the gallbladder.  Gallbladder polyps are benign growths initially, but if they increase in size during follow-up or grow rapidly, they may develop into gallbladder cancer which has a very poor prognosis.

Types of Gallbladder Polyps

There are different types of gallbladder polyps, including benign and malignant polyps:

Benign Tendency	Malignant Tendency
1. Pseudopolyps: Also known as cholesterol polyps, often occur due to the buildup of extra cholesterol that sticks to the gallbladder wall. 2. Inflammatory polyps: These occur due to the presence of chronic inflammation in the gallbladder wall (cholecystitis). 3. Adenomyomatosis: An abnormal formation of cysts on the gallbladder lining.	1. Adenomas (True Polyps): These are benign glandular tumours, but possess 0.5% risk for malignancy (pre-cancerous). 2. Adenocarcinoma: The most common type of malignant polyps, these are cancerous growths that develop from the gallbladder wall.

Do Gallbladder Polyps Cause Symptoms?

Gallbladder polyps in general do not cause any particular symptoms. They are mainly incidental findings on imaging studies such as ultrasound or CT scans. Hence, most patients are unaware of existing polyps. In rare cases, gallbladder polyps growing near the neck of the gallbladder may obstruct the flow of bile out of the gallbladder, leading to obstruction and cholecystitis (inflammation of the gallbladder).

Gallstones vs Gallbladder Polyps: Key Differences

How Are Gallstones Managed?

In terms of gallstone treatment, the most common form of treatment involves surgical removal using key-hole surgery ( laparoscopic cholecystectomy). This surgery has a very rapid recovery to normal and requires only a short hospitalisation. However, not all gallstones require such treatment from the get-go.

When Gallstones Do Not Need Treatment

When gallstones are an incidental finding and not causing any abdominal symptoms, the patients have an option to observe and avoid surgery. However, all patients with gallstones are always warned about the potential risks and complications that can arise from gallstones and to watch for these symptoms and signs. Emergency treatment of gallstone complications has higher riss and the surgery is also more complex.

When Gallstones Treatment Is Required

Once a gallstone starts to cause symptoms then surgical removal via key-hole laparoscopic surgery is required. If patients have had a complication from gallstones like pancreatitis or juandice from obstruction of the bile ducts, then the specialsit will also recommend removal of the gallbladder to prevent future similar life threatneing complications from recurring.

 Treatment Options for Gallstones

Today, surgical removal of gallstones is still the standard of care for gallstone treatment. The reason for doing so is to prevent the recurrence of gallstones, which is highly likely if only the gallstones are removed.

How Are Gallbladder Polyps Managed?

By principle, polyps cannot disappear on their own. However, for those that do not cause discomfort to patients or are small in size, regular monitoring with ultrasound of the gallbladder is sufficient before further action is required. In cases where a patient is observed to have rapidly growing polyps or a large polyp > 1 cm (sign of cancer risk),   removal of the gallbladder may be indicated. As a rule of thumb, specialists will refer to the following flowchart when determining whether immediate action is necessary to manage gallbladder polyps.

Monitoring Small Gallbladder Polyps

Polyps that are small in size (< 1 cm) and asymptomatic can generally be managed through routine observation by a specialist. During the monitoring phase via an ultrasound test, the size of the polyps will be continuously observed to ensure they do not rapidly increase in size (a potential sign of malignancy) or cause new symptoms and/or complications. Beyond a certain threshold, your specialist may determine if intervention is necessary.

When Surgery Is Recommended for Gallbladder Polyps

As highlighted, polyps that are deemed to (potentially) impact a patient's quality of life, an intervention is likely recommended. To date, there is no available solution to manage gallbladder polyps other than surgical removal. That said, removal of the gall bladder is unlikely to cause a significant impact on the patient and they will be able to maintain a good quality of life. Today,  a minimally invasive option is available for gallbladder removal to help patients with better and quicker recovery.

Can Gallstones and Gallbladder Polyps Occur Together?

Gallstones and gallbladder polyps can occur together and they are often detected at the same time incidentally during an ultrasound. In most cases, a surgery is likely recommended as the presence of gallstones can increase the cancer risk of gallbladder polyps.

When Should You See a Specialist?

Experiencing persistent symptoms like post-meal abdominal pain, discomfort, bloating or nausea can understandably be confusing, as it could be due to a multitude of underlying conditions. Under such circumstances, a patient should see a specialist to get advice and recommendations.

For gallstone treatment and gallbladder polyp management, patients often need to consult a General Surgeon who is trained and experienced in minimally invasive laparoscopic surgery. oIn Singapore, you can visit ACE Specialist Surgery and Endoscopy Centre, helmed by Senior ConsultantGeneral Surgeon, Dr Reyaz Singaporewalla. He has more than 2 decades of experience in successful management of both simple and complex gallbladder surgeries.

References

1. Gallstones (Cholelithiasis): Symptoms, Causes & Treatment. Cleveland Clinic
   Cleveland Clinic. (2024, January 15). Gallstones. https://my.clevelandclinic.org/health/diseases/7313-gallstones
2. Gallbladder: What It Is, Function, Location & Anatomy. Cleveland Clinic
   Cleveland Clinic. (2021, July 28). Gallbladder. https://my.clevelandclinic.org/health/body/21690-gallbladder
3. Gallbladder Polyps: Symptoms, Causes & What It Is. Cleveland Clinic
   Cleveland Clinic. (2021, October 1). Gallbladder polyps. https://my.clevelandclinic.org/health/diseases/21821-gallbladder-polyps
4. Gallstones – Conditions & Treatments. SingHealth
   SingHealth. (n.d.). Gallstones – conditions & treatments.  https://www.singhealth.com.sg/symptoms-treatments/gallstones