Agenesis of the Gallbladder: Role of Clinical Suspicion and Magnetic Resonance to Avoid Unnecessary Surgery

Abstract

Isolated agenesis of the gallbladder is usually a rare asymptomatic anatomical variation, with an estimated incidence of 10-65 per 100,000. Females are more commonly affected (ratio 3: 1), with the disease typically presenting in the second or third decade of their life. Despite an absent gallbladder, half of the patients present with symptoms similar to biliary colic, which is poorly understood. The rarity of this condition combined with its clinical and radiological features often lead to a wrong preoperative diagnosis so that many patients undergo unnecessary operative intervention. Herein, we present the case of a 56-year-old female with a typical biliary colic who was diagnosed to have gallbladder agenesis. Computed tomography and magnetic resonance cholangiopancreatography allowed correct treatment and prevented an unnecessary intervention.

Keywords: Biliary colic; Conservative management; Gallbladder agenesis; Magnetic resonance cholangiopancreatography.

Fig. 1

Sonography of the biliary system demonstrating an 11-mm dilatation of the common hepatic duct and no evidence of the gallbladder.

Fig. 2

a Coronary computed tomography scan of the liver and biliary system demonstrating dilatation of the common hepatic duct and absence of the gallbladder and cystic duct (red arrow). b Axial computed tomography scan of the hepatobiliary system revealing absence of the gallbladder and cystic duct and dilatation of the common hepatic duct (red arrow). The image was read by the radiologist as “status postcholecystectomy”.

Fig. 3

Magnetic resonance cholangiopancreatography (MRCP) represents agenesis of the gallbladder, confirming agenesis of the gallbladder and cystic duct (red arrow). MRCP is considered the test of choice if there is suspicion of a hypoplastic gallbladder. It is also helpful in demonstrating an ectopic gallbladder along with other possible anomalies of the biliary tract system.