Abstract
Gallbladder agenesis is a rare anatomic congenital abnormality caused by the cystic bud failing to develop into the gallbladder. Gallbladder agenesis has a variable presentation, with 50% of patients presenting with symptoms mimicking biliary colic and 35% being incidentally discovered during surgery or autopsy, while another 15% can present with fatal fetal anomalies.In this article, we present a case of gallbladder agenesis in a young woman who presented with biliary-colic-like symptoms suggesting cholecystitis. The gallbladder was not well visualized on ultrasonography, simulating chronic cholecystitis due to shrunken or contracted bladder. Further imaging with computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) helped in the successful diagnosis of gallbladder agenesis and helped prevent unnecessary surgical intervention.Due to the lack of clinical suspicion diagnosing gallbladder agenesis preoperatively is still rare. Persistent symptoms are often associated with biliary colic pain leading to surgery. Conservative management consists of using antispasmodic medications. MRCP may be required to rule out gallbladder agenesis and avoid unnecessary surgery.Gallbladder agenesis can present with symptoms similar to cholecystitis. If the gallbladder is not visualized well on the ultrasound, an additional radiological examination is required. Clinicians’ understanding of the condition helps to accurately diagnose the condition preoperatively using the appropriate investigations, thereby minimizing the operative risk to the patient.
Highlights
Gallbladder agenesis is a congenital anomaly in the biliary system that was first reported in 1701 by Lemery et al [1]
We present a clinical case of gallbladder agenesis mimicking and presenting as chronic cholecystitis
Though the exact pathogenesis is unknown, gallbladder agenesis is thought to be due to the failure of the cystic bud to develop further or to the failure of vacuolation [6]
Summary
Gallbladder agenesis is a congenital anomaly in the biliary system that was first reported in 1701 by Lemery et al [1]. We present a clinical case of gallbladder agenesis mimicking and presenting as chronic cholecystitis. A 20-year-old female was referred to the radiology department with suspicion of cholelithiasis She had recurrent dyspeptic symptoms with upper abdominal discomfort and bloating. The patient was reviewed again with overnight fasting for the purpose of visualization of the gallbladder. The common bile duct, common hepatic duct, and rest of the biliary structures appeared normal (Figure 5). FIGURE 5: 3D MRCP ASSET image showing a normal biliary tree with gallbladder absent. Possible future symptoms were discussed, and a yearly follow-up was advised
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