. moderate enlargement of up to 200300  ml is common in surgical practice due to various pathological conditions ; in such cases the gallbladder fundus reaches the level of the anterior superior iliac spine . however , reports of a gallbladder of extreme size  with a weight exceeding that of the liver ( 1.5  kg )  are rare . in such cases , the gallbladder has lost its usual outlines and has acquired a balloon - shaped form . we could find only eight cases in the literature from the 18th century ( table 1 ) . the pathogenesis of the development of a giant gallbladder remains obscure ; some authors believe that it may have expanded this much due to a valve - like mechanism associated with three possible conditions : a stone(s ) , a tumour , or a  wandering gallbladder a 77-year - old woman was admitted to our hospital with a six - month history of dull pain in the right half of the abdomen that had become more severe over the previous several days ; a palpable mass in the same place which the patient had not noticed before ; and loss of about 15  kg in body weight . examination revealed a slight asymmetry of the abdomen due to the right side being swollen , and a large mass on the right side of the abdomen extending from the hypochondrial region to the level of the right anterior superior iliac spine . the gallbladder was found to be extremely enlarged , approximately 172  mm    161  mm    240  mm , containing a partial septum separating its lumen into two unequal chambers . the proximal chamber included two floating stones of 12  mm and 14  mm in diameter . the posterior gallbladder wall displaced the right kidney dorsally and downwards , and its anterior wall was responsible for the distention of the right half of the anterior abdominal wall . the pericholecystitic fat tissue was wiry and contained multiple enlarged lymph nodes ( up to 10  mm in size ) ( fig . , a giant roundish mass was discovered , coming from under the right lobe of the liver . it was decided to puncture and empty the sac with a trocar , which released about 3.35  l of its contents . the first portion of the fluid ( about 3  l ) looked whitish , cloudy , and viscous ; the subsequent portion ( about 350  ml ) was a light - golden , transparent bile . 2 ) , and a 3  mm cystic duct was discovered , emptying into the common bile duct , which had a normal outer width of 7  mm . the inner surface of the removed organ was covered in pink cellular mucosa , and the outer surface and the width of the wall both resembled those of the stomach . the gallbladder consisted of two unequal chambers divided by a high septum : the balloon - shaped larger one which contained mucus , and the proximal , smaller one in the form of a cone , which contained bile and two cholesterol  mulberry stones . the inner surface of the specimen was trabecular , similar to that of the urinary bladder . the mucosal lining of the upper chamber ( containing mucus ) was flattened and consistent with that of gallbladder hydrops . a relatively limited growth of enterococcus faecalis ( 100  cfu1/ml ) was found in the mucus ; it was highly sensitive to all routine antibiotics . at 18-month follow - up , computed tomography revealed that the outer width of the common bile duct was 8  mm . the pancreatico - biliary junction was found to be y - shaped , forming on the level of the duodenal wall ( fig . this disproved our working hypothesis that the development of a giant gallbladder may share a common mechanism with the development of congenital choledochal cysts , as suggested by babbitt et al . to the best of the authors knowledge , no borders have ever been proposed to distinguish between simply enlarged and giant gallbladders . if the volume of the organ exceeds 1.5  l , so that its weight is comparable or even exceeds the mean ( estimated ) weight of the adult liver . the first clinical presentation of the entity will differ from any other gallbladder disease , but instead resembles a tumour or cyst of the abdominal cavity . alongside a valve - like mechanism making the gallbladder distend ( for example , a stone ) , non - obstructive ways to alter the organ drainage may exist : nervous , hydraulic , or both . in younger patients , congenital anomalies we believe that , alongside a valve mechanism , there must be exclusively favourable conditions for a gallbladder to become extremely enlarged without either life - threatening complications , or even significant clinical manifestations : ( 1 ) low , if any , bacterial contamination of the bile in the gallbladder ; ( 2 ) good vascularization ; allowing ( 3 ) an appropriate regeneration of the gallbladder wall , allowing it to continue its distension at a steady rate . perhaps , under conditions where the cystic duct is patent intermittently , an enlarged gallbladder itself might act as a kind of trap for the hepatic bile , allowing it to enter but not exit , and thereby creating a self - reinforcing expansionary process . the giant gallbladder is a special clinical and pathological entity of unknown origin that occurs occasionally in surgical practice . it may develop patients of any age , mimicking a gross abdominal tumour or peritoneal cyst . both the diagnostic method and surgical treatment demand non - routine approaches ; early and late follow - up results seem to be favourable . possible effects of gallbladder enlargement ( with a patent cystic duct ) on biliary hydrodynamics warrant further research on biliary system hydrodynamics which might shed light on this condition . written informed consent was obtained from the patient for publication of this case report and accompanying images . a copy of the written consent is available for review by the editor - in - chief of this journal on request . borodach was asked to take part during the operation as a surgeon in the case reported ; he has made a review of literature and translation from russian into english as well ; a contacting author . dr . fedin was an operator - assistant and so called  a surgeon - curator in the case reported . dr . khromova provided the ct diagnostics before the surgical treatment and in a remote follow - up examination in 1.5-year after the operation was performed .
highlightsreports of giant gallbladders are rare and do not exceed eight cases worldwide.we presented here a case of a giant gallbladder and review of literature.we define a gallbladder as 
 giant if the volume of the organ exceeds 1.5  l.a giant gallbladder may develop patients of any age , mimicking an abdominal tumour.diagnostics and treatment of a giant gallbladder demand non - routine approaches .