Endoscopic Ultrasound in the Diagnosis of Gallbladder Adenomyomatosis Following Inconclusive Transabdominal Ultrasonography: A Case Report

Abstract

Background: Gallbladder adenomyomatosis (GA) is a benign hyperplastic condition characterized by epithelial proliferation, muscular hypertrophy, and the formation of Rokitansky–Aschoff sinuses. Transabdominal ultrasonography (TAUS) is the primary imaging modality for evaluating gallbladder pathology; however, focal wall thickening may pose a diagnostic challenge, particularly when differentiation from early gallbladder carcinoma is required. Endoscopic ultrasonography (EUS), with its high spatial resolution, enables detailed assessment of the gallbladder wall and may provide additional diagnostic information when TAUS findings are indeterminate.
Case Report : A 52-year-old woman presented with intermittent right upper quadrant pain for two months. Physical examination revealed mild right upper quadrant tenderness without jaundice or fever. Laboratory investigations, including liver function tests and serum tumor markers, were within normal limits. TAUS demonstrated focal gallbladder wall thickening measuring 7 mm at the fundus, with multiple echogenic foci but no definite comet-tail artifacts, raising suspicion of a neoplastic lesion. EUS demonstrated preserved gallbladder wall stratification, multiple intramural cystic spaces, and characteristic comet-tail artifacts arising from Rokitansky–Aschoff sinuses, favoring a diagnosis of GA. Because of persistent symptoms and the inability to completely exclude neoplasia, the patient underwent laparoscopic cholecystectomy. Histopathological examination confirmed fundal-type GA without dysplasia or malignancy. Postoperative recovery was uneventful, and the patient remained symptom-free at six-month follow-up.
Conclusion: This case illustrates the complementary diagnostic value of EUS in the evaluation of gallbladder wall thickening when
TAUS findings are inconclusive. Recognition of characteristic EUS features, including preserved wall stratification, intramural cystic
spaces, and comet-tail artifacts associated with Rokitansky–Aschoff sinuses, may increase diagnostic confidence in GA and assist in
appropriate clinical decision-making.

BJusg. vol. 27, no. 1, June 2026, Page: 65-69