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Topic

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Neck of gallbladder

The neck of the gallbladder is the narrow, funnel-shaped portion that connects the body of the gallbladder to the cystic duct. It lies at the right end of the porta hepatis, directed upward and backward, and is often slightly curved. The mucosa of the neck contains spiral folds known as the spiral valve of Heister, which help maintain patency of the cystic duct.

Just distal to the neck, a small mucosal outpouching called Hartmann’s pouch is frequently present. This pouch is a common site of gallstone impaction, which can compress the common hepatic duct and cause Mirizzi syndrome.

The neck serves as the transition point between the gallbladder reservoir and the biliary tree, regulating bile flow into the cystic duct and storage/release functions of the gallbladder. Its location and relationships make it a critical structure in cholecystectomy surgery, as it lies close to the cystic artery and hepatic ducts in the Calot’s triangle.

Synonyms

  • Cervix of gallbladder

  • Gallbladder funnel

  • Hartmann’s pouch (closely associated structure)

Function

  • Acts as a conduit for bile from gallbladder body to cystic duct

  • Maintains flow patency with the spiral valve of Heister

  • Functions as a physiological narrowing, a common site of gallstone obstruction

  • Serves as an important surgical landmark during cholecystectomy

Nerve Supply

  • Parasympathetic: Vagus nerve (via celiac plexus)

  • Sympathetic: Celiac plexus fibers

  • Sensory: Right phrenic nerve (referred pain to right shoulder)

Arterial Supply

  • Cystic artery (branch of right hepatic artery) supplies the neck along with gallbladder body

Venous Drainage

  • Drains via cystic veins into the portal vein or directly into intrahepatic portal branches

MRI Appearance

T1-weighted images:

  • Gallbladder wall: low signal

  • Lumen: variable signal depending on bile concentration (high protein bile appears hyperintense)

T2-weighted images:

  • Lumen: bright hyperintense due to bile fluid

  • Neck may appear as a tapering, tubular structure connecting to cystic duct

  • Gallstones appear as signal voids

STIR:

  • Suppresses fat, highlighting the gallbladder neck and pericholecystic fluid as bright hyperintensity

  • Useful in acute cholecystitis to detect inflammation or edema

T1 Fat-Saturated (Pre-contrast):

  • Gallbladder wall shows intermediate signal, bile variable

  • Gallstones show signal void against suppressed fat background

T1 Fat-Saturated Post-Contrast (Gadolinium):

  • Gallbladder wall enhances uniformly if normal

  • Thickened, irregular, or hyperenhancing wall indicates cholecystitis or neoplasm

  • Hartmann’s pouch enhancement useful in assessing impacted stones

MRI Non-Contrast 3D MRCP (Magnetic Resonance Cholangiopancreatography):

  • Shows gallbladder neck tapering into the cystic duct

  • Detects stones, strictures, and cystic duct obstruction

CT Appearance

CT Pre-Contrast:

  • Gallbladder neck appears as a fluid-density structure tapering to cystic duct

  • Gallstones may appear as hyperdense foci (calcified) or isoattenuating (cholesterol stones, less visible)

CT Post-Contrast:

  • Wall enhances mildly and uniformly in normal state

  • Thickened, irregular, or hyperenhancing wall indicates inflammation, infection, or malignancy

  • Pericholecystic fluid collections are well visualized in acute cholecystitis

MRI image

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MRI image

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CT images

neck of gallbladder CT axial image

CT images

neck of gallbladder CT coronal image

MRI image

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