{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 27, Ep 2 of 4: Uncommon Gallbladder Presentations","html":"","width":"100%","height":180,"duration":938,"description":"Episode two covers the less common gallbladder presentations, and the thread running through all of them is the same: chronic inflammatory remodeling around the gallbladder distorts the anatomy enough to change either the operation, the cancer risk, or the diagnostic frame. Stone-driven inflammation at Calot's triangle either compresses the bile duct from outside in Mirizzi, calcifies the wall in porcelain gallbladder, or erodes into bowel in gallstone ileus and Bouveret. The Csendes stage sets the reconstruction, the calcification pattern sets the cancer indication, and the level of stone impaction sets endoscopy versus surgery. Polyps test on a clean size rule with risk-factor modifiers, and functional gallbladder disorder tests on the discipline not to operate, because the failure mode is over-treating a heterogeneous category.\n \nTopics covered\n\nMirizzi syndrome and the Csendes classification\nMRCP staging and open conversion risk\nPorcelain gallbladder and calcification pattern\nCholecystenteric fistula and gallstone ileus\nBouveret syndrome and gastric outlet obstruction\nGallbladder polyps and the size threshold\nGallbladder adenocarcinoma biology\nPancreaticobiliary maljunction\nFunctional gallbladder disorder and over-treatment\n \n \nKey decisions\n\nIn Mirizzi syndrome the Csendes stage dictates the operation: external compression or a small fistula allows cholecystectomy or primary repair over a T-tube, while destruction of two-thirds or more of the duct wall requires hepaticojejunostomy.\nMRCP is the study of choice in suspected Mirizzi because it shows the stone, duct compression, and any fistula without instrumenting, and dense inflammation at Calot's triangle mandates open conversion with intraoperative cholangiography.\nMucosal, incomplete, or focal porcelain gallbladder calcification remains an indication for prophylactic cholecystectomy, while complete circumferential transmural calcification can be observed in selected high-risk surgical patients.\nGallstone...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}