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Background: The differential diagnosis of gallbladder adenomyomatosis is not always easy and, many times, the option is surgical. The aim of the present study was to report the diagnostic strategy for gallbladder adenomyomatosis in an asymptomatic older patient. Case presentation: A 76-year-old female patient was sent to the digestive tract surgery service of the Cuiabá Santa Casa Hospital in Brazil due to evidence of polyps in the gallbladder diagnosed by tomography during the follow-up of repeated urinary infections. The tomogram revealed irregular thickness with the densification of adipose planes of the fundus of the gallbladder without dilation of the bile ducts. Magnetic resonance cholangiopancreatography was performed for a better assessment of the gallbladder and biliary tree. The exam revealed heterogenous intraluminal structures in the fundus region of the gallbladder, with focal points of hypersignals in T2 and an area highlighted by the para-magnetic contrast medium measuring 2.0 cm along the longest axis and colonic diverticulosis with no signs of infection. Surgery was performed and the histopathological analysis revealed gallbladder adenomyomatosis. Conclusion: In cases of diagnostic doubt and considering the possibility of malignancy, the option should be surgery.

DIAGNOSTIC DIFFICULTY AND STRATEGY FOR GALLBLADDER ADENOMYOMATOSIS