Gallbladder Agenesis Mimicking Chronic Cholecystitis in a Young Woman

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.

Keywords: abdominal laparoscope; abdominal radiology; biliary colic; chronic abdominal pain; direct primary care; gall blader disease; gallbladder agenesis; magnetic resonance cholangiopancreatography.

Figure 1. Ultrasound image of the gallbladder fossa showing linear echogenicity representing bowel shadows.

Figure 2. Coronal reformatted non-contrast CT image showing empty gallbladder fossa (arrow). No radio-dense calculi were seen in the biliary system.

CT- Computed Tomography

Figure 3. Axial non-contrast CT showing fat in the gallbladder fossa (arrow) with non-visualization of the gallbladder.

CT - Computed Tomography.

Figure 4. Coronal 2D FIESTA sequence of MRCP showing non-visualization of the gallbladder in the gallbladder fossa with normal common hepatic and common bile ducts.

2D FIESTA - Two-Dimensional Fast Imaging Employing Steady-state Acquisition; MRCP - Magnetic Resonance Cholangiopancreatography

Figure 5. 3D MRCP ASSET image showing a normal biliary tree with gallbladder absent. The common bile duct (green arrow), common hepatic duct (blue arrow), and pancreatic duct (orange arrow) appear normal in caliber and course.

3D MRCP ASSET - Three Dimensional array spatial sensitivity encoding technique.