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SUMMARYGallbladder agenesis is a rare congenital anomaly. Choledochal cysts are uncommon. The combination of both these entities in a 56-year-old woman is reported. A previously fit and well woman, presented to the emergency department with a 3-day history of abdominal pain. Preoperative imaging and intraoperative findings confirmed gallbladder agenesis and a type I choledochal cyst. There were no other anomalies. She underwent a resection of the choledochal cyst and reconstruction by hepaticojejunostomy. BACKGROUND

Testicular tuberculosis (TB) is rare, and, because of this, the lack of pathognomonic clinical features and its tendency to mimic other commoner conditions, the diagnosis is frequently delayed or may be missed. In this case, the initial clinical presentation was typical for bacterial epididymo-orchitis in a 38-year-old man. When the patient failed to improve with standard treatment including broadening of antibiotics, the diagnosis was re-considered because some unusual signs suggested testicular malignancy or lymphoma. Further, history-taking and subsequent cross-sectional imaging with CT/MRI identified co-existent pulmonary nodularity, thoracic and abdominal lymphadenopathy and bony changes that, together, raised the suspicion of TB. Mycobacterium tuberculosis was confirmed on DNA-based testing of the hydrocele fluid, although standard acid-fast bacilli culture was negative. This case prompted a review of the literature to explore the optimal steps in the investigation and diagnosis of this rare disease.

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