Akritidis N, Mantzios G, Pappas G
Internal Medicine Department, Peripheral General Hospital, G. Hatzikosta, Ioannina, Greece.
Hepatogastroenterology. 2001 Jan-Feb;48(37):112-3.
Gallbladder adenomyomatosis is a rare disorder, characterized by benign hyperplasia of the gallbladder mucosa creating invaginations through the muscular layer, known as Rokitansky-Aschoff sinuses. It is considered an acquired disease, with pathophysiology similar to that of the diverticular disease of the colon. Diagnosis is often achieved by ultrasound, but a significant percentage is misdiagnosed as chronic cholecystitis, whereas the diagnosis is finally achieved histologically. We describe a case of gallbladder adenomyomatosis presenting as fever of unknown origin. The patient was a 17-year-old girl with a history of sustained fever of 38.5 degrees C of two months' duration. There were no accompanying symptoms and the whole diagnostic workup, including abdominal ultrasound, was negative. Gallbladder inflammation was evident during an eventual investigatory laparoscopy, and cholecystectomy was performed. The histologic results were consistent with diffuse adenomyomatosis. The patient became afebrile immediately after cholecystectomy. To our knowledge, fever has never been associated with gallbladder adenomyomatosis before in bibliography, nor has adenomyomatosis been mentioned as a cause of fever of unknown origin. We therefore believe that gallbladder adenomyomatosis should be considered in the differential diagnosis of sustained fever with negative workup.
胆囊腺肌增生症是一种罕见的疾病，其特征是胆囊黏膜良性增生，形成穿过肌层的内陷，即罗-阿窦。它被认为是一种后天性疾病，病理生理学与结肠憩室病相似。诊断通常通过超声检查，但有相当比例被误诊为慢性胆囊炎，最终通过组织学检查确诊。我们描述了一例以不明原因发热为表现的胆囊腺肌增生症病例。患者是一名17岁女孩，持续发热38.5摄氏度达两个月。无伴随症状，包括腹部超声在内的整个诊断检查均为阴性。在最终的探查性腹腔镜检查中发现胆囊炎症，遂行胆囊切除术。组织学结果与弥漫性腺肌增生症一致。胆囊切除术后患者立即退热。据我们所知，文献中此前从未将发热与胆囊腺肌增生症相关联，也未提及腺肌增生症是不明原因发热的病因。因此，我们认为在对检查结果阴性的持续发热进行鉴别诊断时应考虑胆囊腺肌增生症
