Gallbladder agenesis with no other biliary tract abnormality: report of a case and review of the literature

Abstract

We report a rare adult case of gallbladder agenesis with no other biliary tract abnormality. The patient was a 29-year-old man with pain in the right upper-quadrant of the abdomen, and vomiting. The gallbladder was not visualized by ultrasonography, computed tomography, or endoscopic retrograde cholangiography. The common bile duct was slightly dilated. No other abnormalities, including anomalous choledochopancreatic duct junction, were found. Based on these imaging findings and the patient's right hypochondrial pain, there was a high index of suspicion of chronic cholecystitis caused by incarcerated gallstones in the neck of the gallbladder. At operation, we carefully observed the gallbladder fossa, using laparoscopy, and found gallbladder to be absent. Although the operation involved only observation via a laparoscope, the patient has since remained well and asymptomatic. It is difficult to make a correct diagnosis of gallbladder agenesis preoperatively. We believe that, if the gallbladder is not visualized by imaging techniques, it may be better to perform laparoscopy for observation before performing laparotomy, in order to reduce surgical stress.

Agenesis of gallbladder: A diagnostic dilemma

“…Gallbladder develop late in first month of intrauterine life from distal part of hepatic diverticular bud of the foregut. Agenesis of gallbladder is explained by two developmental theories [8,9] during laparoscopy for evaluation of (colicky) pain right hypochondrium (90%), dyspepsia, vomiting. Cause of pain in symptomatic patients includes biliary dyskinesia, adhesion in the GB fossa or periportal adhesions, remnant cystic duct stone and choledocholithiasis.…”

Agenesis of the gallbladder as a rare misdiagnosis

“…It has been suggested that this condition represents an inheritable congenital developmental defect [6]. Gallbladder agenesis is usually asymptomatic, but 35% to 60% of the patients may have symptoms compatible with a biliary disorder like cholelithiasis [4,5]. However, it has been reported that patients with gallbladder agenesis will have at least one symptom suggestive of biliary tract disease during their lifetime, and bile duct stones will be found in 25% to 60% of these cases [6].…”

“…Gotohda et al [5] stated that if the gallbladder is not visualized by imaging techniques, laparoscopy should be performed before laparotomy. However, laparotomy can be avoided and the risk of any possible complications reduced by the laparoscopic surgeon's awareness of the problems posed by this anomaly and a careful review of currently available diagnostic tests [16].…”

“…Even if biliary agenesis is diagnosed during surgery, the surgeon may not be aware of the accompanying pathologic conditions, and a delay in the proper patient guidance may result. Biliary agenesis could be misdiagnosed radiologically as cystic duct obstruction or acute cholecystitis or chronic cholecystitis in patients in whom the gallbladder is not seen during ultrasonographic examination, since shrunken and scarred gallbladder tissue is difficult to visualize in chronic inflammatory conditions [4,5]. In this report, we describe such a case of gallbladder agenesis that was diagnosed both at surgery and during postsurgical MRI scanning after a prior false diagnosis of cholelithiasis and chronic cholecystitis.…”

A Choledochal Cyst Resulting In Obstructive Jaundice In A Case With Gallbladder Agenesis: Report Of A Case And Review Of The Literature

“…AGB results from the failure of the cystic bud to develop in the 4 th week of intrauterine life. It normally develops from the caudal part of the hepatic diverticulum (1,2). CCs are single or multiple dilatations of the intrahepatic or extrahepatic biliary tree.…”