Patient: Female, 24Final Diagnosis: Gallbladder agenesisSymptoms: —Medication: —Clinical Procedure: —Specialty: Gastroenterology and HepatologyObjective:Rare diseaseBackground:Gallbladder agenesis (GA) is an extremely rare anatomic anomaly with a reported incidence of less than 0.5%. It is usually asymptomatic, but can present with features of biliary colic and cholecystitis. We present here a case of GA in a patient with recurrent biliary colic.Case Report:A 24-year-old African American woman presented with recurrent episodes of right upper-quadrant abdominal pain. During her first episode, she was found to have elevated transaminases and clinical features of cholecystitis, but ultrasound did not visualize a gallbladder and she was discharged with a diagnosis of biliary colic. She returned within a week with worsening liver enzymes, severe pain, and vomiting. A hepatobiliary iminodiacetic acid (HIDA) scan was done, which again did not show the gall bladder. On clinical suspicion of acute cholecystitis, she underwent laparoscopic surgery. Intraoperatively, the gall bladder fossa was empty and a diagnosis of gall bladder agenesis was made. She presented a third time with similar complaints and magnetic resonance cholangiopancreatography (MRCP) was done, which showed normal biliary tract anatomy and absent gall bladder. A diagnosis of sphincter of Oddi dysfunction was made and she was discharged on antispasmodics.Conclusions:Diagnosing GA is challenging. The rarity of this entity combined with classic clinical features of cholecystitis and non-visualization of the gall bladder on routine investigation prompts unnecessary surgical intervention. Awareness of this condition, along with use of better imaging modalities like preoperative MRCP, can aide physicians to appropriately manage this uncommon clinical condition.
Introduction: The use of polyethylene glycol-based solutions is the gold standard for bowel preparation for colonoscopy. However, polyethylene glycol use might be associated with the risk of acute kidney injury. We aim to find out acute kidney injury and risk factors associated with the development of acute kidney injury in patients using polyethylene glycol for colonoscopy.Materials and Methods: This was an observational study conducted in the Department of Nephrology and Gastroenterology, Bir hospital. Patients who underwent colonoscopy using polyethylene glycol were included in the study and assessed for acute kidney injury; its incidence, association of risk factors with acute kidney injury, and outcome (complete recovery or no recovery) of acute kidney injury by 3 months.Results: The mean age of the patients was 45.81 ± 18.60 years with the majority of the patients being male (60%). Out of 48 study participants, 4(8%) develop acute kidney injury. Multivariate regression analysis depicted that chronic kidney disease, chronic liver disease, congestive cardiac failure, and use of non-steroidal anti-inflammatory drugs, angiotensin receptor blockers, and diuretics drugs were the predictors which significantly influenced the occurrence of acute kidney injury in patients using polyethylene glycol.Conclusions: The evidence strongly suggests that in patients without preexisting renal disease, comorbidities, or use of drugs; the risk of renal impairment is low after colonoscopy using polyethylene glycol as a bowel cleansing agent. In the presence of risk factors for renal dysfunction, polyethylene glycol should be used cautiously.
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