Surgery · Hepatobiliary Surgery (Liver Tumors, Gall Bladder, Bile Duct, Pancreas)

A 50-year-old woman is found to have a 2.8 cm incidental gallbladder polyp on ultrasound. She has no symptoms and no cholelithiasis. The most appropriate management is:

  • A Cholecystectomy
  • B Repeat ultrasound in 6 months
  • C Endoscopic ultrasound to characterise the polyp
  • D CT abdomen to assess lymphadenopathy
Correct answer: A. Cholecystectomy

Explanation

Gallbladder polyps ≥1 cm carry a significant risk of being adenomatous and potentially malignant (gallbladder adenocarcinoma). The threshold for cholecystectomy is a polyp ≥10 mm (some guidelines 6 mm with risk factors). A 2.8 cm polyp far exceeds this threshold and mandates cholecystectomy. Watchful waiting with ultrasound surveillance is reserved for polyps <6 mm.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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