Gallbladder agenesis diagnosed intra-operatively: a case report

Malde, Sachin

doi:10.1186/1752-1947-4-285

Cited by 66 publications

(100 citation statements)

References 9 publications

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“…Lemery and Bergman first reported this condition in 1701 (10). The incidence rate of gallbladder agenesis in countries other than China has been found to be 0.013-0.065% (11). The present case of gallbladder agenesis was confirmed during a surgical intervention in the patient during his initial visit to our hospital.…”

Section: Discussionsupporting

confidence: 52%

Gallbladder agenesis and atrial septal defect: A case report

Liu

Zhao

2016

Experimental and Therapeutic Medicine

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Abstract. Congenital absence of gallbladder and atrial septal defect (ASD) are clinically rare congenital organ malformations, and the simultaneous occurrence of the two is even more rare. The present study reported a case of gallbladder agenesis combined with congenital ASD. A 38-year-old male patient presented with a 3-year history of recurring upper right abdominal pain. The pain had no evident cause and was accompanied by dyspepsia and gasteremphraxis with indigestion. Several color Doppler ultrasonography scans revealed cholecystitis and gallbladder stones. A physical examination revealed cardiac murmur. A color Doppler ultrasonography of the heart was indicative of congenital heart disease. A corrective surgery for ASD was performed. Subsequently, a mini-incision cholecystectomy was performed as explorative surgery. A magnetic resonance cholangiopancreatography scan of the abdomen was performed in order to confirm the diagnosis of gallbladder disorder and cystic duct hypoplasia. A final definite diagnosis of gallbladder agenesis was confirmed. In conclusion, atrophy and gallbladder full of stones are frequently misdiagnosed, and establishing a definitive preoperative diagnosis is difficult. Awareness of this congenital malformation may assist physicians in distinguishing cases with unclear manifestation and avoiding unnecessary surgical interventions. IntroductionConcurrent manifestation of congenital absence of gallbladder and atrial septal defect (ASD) is a rare congenital organ malformation in clinical practice (1). No apparent association has been identified between these two congenital organ malformations. Sufficient attention must be paid to these disorders as they are often misdiagnosed or overlooked during diagnosis. The incidence of gallbladder agenesis in the general population is reported to be 13-65/100,000 (2). In clinical practice, the incidence is 0.007-0.0027%, while in autopsy series it is 0.04-0.13% (3). Females are more commonly affected (ratio, 3:1), and >50% of patients with gallbladder agenesis are symptomatic and require surgical intervention (4,5). It is crucial that clinicians consider gallbladder agenesis in cases where the gallbladder appears abnormal on preoperative imaging studies and cannot be identified using laparoscopy (6). Preoperative diagnostic imaging such asmagnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound should be considered. If such a condition is encountered during surgery, intraoperative cholangiography and intraoperative ultrasound may be performed to rule-out agenesis and ectopic gallbladder (7). In the present case report, the diagnosis and surgical intervention of gallbladder agenesis and ASD is described. Case reportA 38-year-old male visited the Affiliated Hospital of Inner Mongolia Medical University (Hohhot, China) in December 2010 with a 3-year history of recurring upper right abdominal pain, which had deteriorated in the last week. The pain had no evident cause. It was accompanied by dyspepsia and gasteremphraxis with indigesti...

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Section: Discussionsupporting

confidence: 52%

Gallbladder agenesis and atrial septal defect: A case report

Liu

Zhao

2016

Experimental and Therapeutic Medicine

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“…3) Symptomatic group (50%): This major group presents in the 4 th or 5 th decades and this is usually an isolated anomaly. In the symptomatic group, common signs are chronic right upper quadrant pain (90%), dyspepsia (30%), nausea and vomiting (66%), fatty food intolerance (37%), and jaundice (35%) (Malde, 2010). The possible mechanisms of symptoms include primary duct stone, biliary dyskinesia or non-biliary disorders.…”

Section: Discussionmentioning

confidence: 99%

“…Patients become symptomatic in 23% of cases, and GA will almost always be misinterpreted as cholecystitis with cystic duct obstruction or as sclero-atrophic gallbladder, therefore, leading to unnecessary surgery (Malde, 2010).…”

Section: Introductionmentioning

confidence: 99%

Agenesis of the Gallbladder Diagnosed by Magnetic Resonance Cholangiography: Report of a Case and Review of the Literature

et al. 2015

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Abstract:Gallbladder agenesis (GA) is a rare congenital anomaly of the biliary system often associated with other congenital abnormalities. Patients become symptomatic in 23% of cases (Richards et al., 1993). GA is often misinterpreted as other diseases, therefore, leading to unnecessary surgery. Many of these patients develop a typical symptomatology of cholelithiasis that leads them to operating theatre. If an operative procedure is done, it is better to remain at the level of laparoscopy because further surgical investigation may lead to detrimental biliary tract injuries (Waisberg et al., 2002). We present a case of GA, diagnosed by magnetic resonance with cholangiopancreatography.

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“…Preoperative MRCP should be considered in cases of USG diagnosis of non-visualization of gallbladder [20]. Other diagnostic modality includes EUS,intra-op ultrasound and selective arteriography can be used for agenesis.…”

Section: Discussionmentioning

confidence: 99%

Agenesis of gallbladder: A diagnostic dilemma

Mittal¹,

Saxena²,

Kadam³

et al. 2015

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. Agenesis of gallbladder is a rare (13-65 cases/100,000) anomaly, in which about 23% patient presents with symptoms of biliary disease. In these patients, ultrasonography (USG) abdomen frequently falsely reveals shrunken or contracted gallbladder and sometimes non-visualization of gallbladder (GB) in GB fossa. Basis of these misinterpreted reports these patients undergone unnecessary surgery and may encounter iatrogenic biliary tract injuries and portal injuries because of excessive dissection to find out the absent gallbladder and ectopic gallbladder.Case Report: A 40-year-old female attended surgical outdoor with complain of pain right hypochondrium and dyspepsia since last four years patient followed-up with USG abdomen which was suggestive of chronic cholecystitis with cholelithiasis, and common bile duct (CBD) was normal in diameter on the basis of clinical symptoms and USG findings patient admitted and planned for laparoscopic cholecystectomy. On laparoscopy after removing the adhesions, exploration done up to the porta but gallbladder could not be visualized.On postoperative day-1 patient was sent for MRCP with MRI abdomen. On MRCP gallbladder and cystic duct were not visualized. CBD was normal in caliber. Liver and pancreas were normal. Hence the diagnosis of agenesis was made. Conclusion: Agenesis of gallbladder is an unusual anomaly in which about 23% presents as biliary disease. These patient frequently undergone surgery because of misinterpreted reports of USG abdomen, ERCP and CT abdomen. So, in cases with ultrasonographic diagnosis of scleroatrophic or non-visualization or suspicious of ectopic gallbladder and absence of wall echo shadow (WES) triad or double arc shadow, when non-visualization of gallbladder is present during laparoscopy or open exploration intraoperative cholangiogram, intraoperative ultrasound and postoperative MRCP or Endoscopic ultrasound (EUS) can help in the diagnosis of agenesis or ectopic gallbladder.

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Gallbladder agenesis diagnosed intra-operatively: a case report

Cited by 66 publications

References 9 publications

Gallbladder agenesis and atrial septal defect: A case report

Gallbladder agenesis and atrial septal defect: A case report

Agenesis of the Gallbladder Diagnosed by Magnetic Resonance Cholangiography: Report of a Case and Review of the Literature

Agenesis of gallbladder: A diagnostic dilemma

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