Polyp of the gallbladder
Hello! I am 42 years old. From the age of 17 I was diagnosed with chronic cholecystitis. It is manifested by the weight and pain in the right hypochondrium, over the years there have been 5-6 bouts of severe pains radiating to the right shoulder, intensifying the pain when inhaling. Recently, there is often bitterness in the mouth. Periodically I do ultrasound, no stones. In September 2007, a gallbladder polyp was first discovered. Ultrasound Protocol September 2007: In the abdominal cavity expressed pneumatization of the intestine. Liver with even clear contour. Right lobe 133 mm, left – 63 mm. Parenchyma is homogeneous, echo is normal, in / hepatic ducts are not extended. Portal vein 9 mm. Gallbladder 80×25 mm with a bend in the neck. Wall 2.5 mm, sealed. Content is homogeneous, parietal determined hyperechoic structure of 3×2 mm with fuzzy outlines by type of polyp. Pancreas with clear even contours. The head is 23×21, the body is 13, the tail is 22 mm, the echo is normal, the Wirsung duct is not extended. Conclusion: Moderately expressed signs of chronic cholecystitis. Polyp of the gallbladder. It was recommended to repeat the ultrasound in six months. The study was done after 9 months, on the same machine, but by another specialist, minutes of June 2008:Liver with even clear contour. The right lobe is 134 mm, the left is 68 mm. The parenchyma is homogeneous, compacted, the echogenicity is moderately increased. Portal vein 9 mm. Gallbladder 66х19 mm bent in n / 3. Wall 3 mm. Content submitted hyperechoic formation with a diameter of 4 mm. Choledoch is not extended. Pancreas with clear slightly wavy contours. Head 22×26, body 13, tail 17 mm, the structure is sealed, with small areas of fibrosis, echo is increased. Conclusion: Polyp of the gallbladder, signs of cholecystitis. Over the past six months, stool disorders have been added to these complaints: 1-2 times a day, plenty of undigested liquid stool, but not daily, such disorders 3-4 times a month for 1-2 days. Consulted with a therapist: recommended observation. Consulted with a surgeon: cholecystectomy is recommended due to the danger of malignancy. The question is: what tactic is now used for gallbladder polyps: delete when a polyp is detected or wait for the appearance of some more signs? What can you advise in my situation: to observe or operate?
Observe and treat. As shown by my personal practice and literature data, more than 95% of formations in the gallbladder, described as ultrasound as polyps, are not polyps. Percentages in 5 cases – the bend of the bladder wall. At least 90% are loose cholesterol stones that do not produce ultrasonic tracks, fixed to the wall, and have a density with respect to ultrasonic waves like a bubble wall. Considering that you are describing a typical clinic of cholecysto-pancreatitis with cholelithiasis, it can be concluded that it is a question of loose choleconment. At this stage of the disease, I am in no hurry to recommend surgical treatment to patients. I recommend to follow the diet 5, for disorders of the chair associated with pancreatitis – taking enzyme preparations courses for 2-3 weeks. At this stage, you can try to cope with the problem with the problem. To do this, I recommend regular 4 meals a day, abundant drinking, preferably broths of choleretic herbs with an osmotic effect – agrimony, immortelle, rosehip – 30-40 minutes before meals, up to 4 weeks, at the same time – taking myotropic antispasmodics (I prefer to prescribe Duspatalin 1t x 2 p / d minimum 4 weeks), ursodeoxycholic acid preparations (Ursosan, Ursofalk), at the rate of 250 mg (1 capsule) per 25 kg of weight 1 time per day n / night, 2 hours after dinner – daily 2-3 months . After 3 months – control ultrasound, while reducing the size and regression of symptoms, you can continue the course of ursodeoxycholic acid. With the growth of education and the preservation of clinical manifestations – surgical treatment. According to this scheme, it is possible to achieve a positive result, up to the dissolution of the calculus, in at least 50% of cases. Agree on this with an in-person consultation with a competent gastroenterological physician (general practitioner or surgeon),