Laparoscopic Management of Long-Standing Gallbladder Hydrops: A Case Report and Literature Review.

Gallbladder hydrops, a condition characterized by distension of the gallbladder with clear serous fluid due to chronic outflow obstruction, is an uncommon clinical entity most often associated with cholelithiasis. It poses a diagnostic and therapeutic challenge, as it can present with a wide spectrum of symptoms, from being an incidental finding to mimicking other abdominal pathologies. This case report illustrates the clinical course of a patient with long-standing, intermittently symptomatic gallbladder hydrops. A 63-year-old woman presented with a four-year history of intermittent right upper quadrant pain. Imaging three years prior (ultrasound and CT) had confirmed the diagnosis of gallbladder hydrops with an impacted stone in the cystic duct. She deferred surgery at that time. Upon re-presentation, imaging revealed a persistently distended gallbladder. She successfully underwent a laparoscopic cholecystectomy, which required intraoperative percutaneous decompression to aspirate 125 mL of clear fluid and facilitate safe dissection. The procedure was uncomplicated, and the patient was discharged on postoperative day one. Histopathology confirmed chronic cholecystitis. This case highlights that gallbladder hydrops can have a prolonged and indolent symptomatic course. Laparoscopic cholecystectomy remains the definitive treatment but can be technically demanding due to the distended, tense gallbladder. Preoperative recognition and preparedness for intraoperative decompression are crucial techniques for minimizing the risk of iatrogenic perforation and ensuring a successful surgical outcome. A review of the literature underscores the variable presentation and management strategies for this condition.