Abstract
IntroductionAgenesis of the gallbladder is a rare congenital anomaly occurring in 13 to 65 people of a population of 100,000. The rarity of the condition, combined with clinical and radiologic features that are indistinguishable from those of more common biliary conditions, means that it is rarely diagnosed preoperatively, and patients undergo unnecessary operative intervention.Case presentationThis case report describes the case of a 79-year-old symptomatic Caucasian man who underwent laparoscopic cholecystectomy for suspected choledocholithiasis despite imaging studies raising suspicion of gallbladder agenesis. Intra-operatively, the diagnosis of gallbladder agenesis and associated common bile duct stones was made.ConclusionThe preoperative diagnosis of this rare condition is difficult to make. However, with advances in biliary tract imaging and with heightened awareness of this anomaly, fewer patients will need to undergo unnecessary operative intervention. The authors review the different imaging modalities available to help diagnose this condition and highlight the importance of being aware of this rare anomaly to avoid an operation that carries a high risk of iatrogenic injury.
Highlights
Agenesis of the gallbladder is a rare congenital anomaly occurring in 13 to 65 people of a population of 100,000
The authors review the different imaging modalities available to help diagnose this condition and highlight the importance of being aware of this rare anomaly to avoid an operation that carries a high risk of iatrogenic injury
Symptoms mimic those of common biliary conditions such as cholecystitis, and routine investigations fail to distinguish between gallbladder agenesis and other conditions such as cholecystitis with cystic duct obstruction or an atrophic gallbladder
Summary
Agenesis of the gallbladder is a rare but well-recognized congenital anomaly, the management of which is conservative. Clinical and radiologic features mimic those of more common biliary conditions, and so patients frequently undergo unnecessary operative procedures. Preoperative MRCP should be considered in cases in which ultrasound suggests nonvisualization of the gallbladder, and surgeons should maintain a low threshold for further investigation before any decision to operate. A conservative approach with follow-up imaging is advocated in cases of doubt to avoid unnecessary operations. Undergo post-operative investigation with the radiologic modalities already described, to prevent the morbidity of conversion to an open procedure. Consent Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review from the journal’s Editor-in-Chief
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