Gallbladder agenesis diagnosed intra-operatively: a case report

Abstract

Introduction: Agenesis 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 presentation: This 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.

Conclusion: The 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.

Figure 1

Pre-operative endoscopic retrograde cholangiopancreatography (ERCP) showing a dilated common bile duct (CBD) with stones and absence of the gallbladder.

Figure 2

Intra-operative cholangiogram confirming common bile duct (CBD) stones and agenesis of the gallbladder.

Figure 3

Suggested decisional tree for the investigation of suspected gallbladder agenesis.