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Case Report
 
Agenesis of gallbladder: A diagnostic dilemma
Atul Kumar Mittal1, Dhananjay Saxena1, Raju Kadam1, Prashant Garg2, Jeevan Kankaria3, Rajkamal Jenaw4
1MBBS, Resident, Department of Surgery, S.M.S. Medical College and Hospital, Jaipur, Rajasthan, India.
2MBBS,MS, General Surgery, Senior Resident, Department of Surgery, S.M.S. Medical College and Hospital, Jaipur, Rajasthan, India.
3MBBS, MS, General Surgery, Associate Professor, Department of Surgery, S.M.S. Medical College and Hospital, Jaipur, Rajasthan, India.
4MBBS, MS, General Surgery, Professor, Department of Surgery, S.M.S. Medical College and Hospital, Jaipur, Rajasthan, India.

doi:10.5348/ijcri-201548-CR-10509

Address correspondence to:
Dr. Atul Kumar Mittal
Department of Surgery, S.M.S. Medical College and Hospital
Jaipur, Rajasthan
India 302017
Phone: 0091- 9530033975

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How to cite this article
Mittal AK, Saxena D, Kadam R, Garg P, Kankaria J, Jenaw R. Agenesis of gallbladder: A diagnostic dilemma. Int J Case Rep Images 2015;6(5):296–300.


Abstract
Introduction: Agenesis of gallbladder is a rare (13–65 cases/100,000) anomaly, in which about 23% patient presents with symptoms of biliary disease. In these patients, ultrasonography (USG) abdomen frequently falsely reveals shrunken or contracted gallbladder and sometimes non- visualization of gallbladder (GB) in GB fossa. Basis of these misinterpreted reports these patients undergone unnecessary surgery and may encounter iatrogenic biliary tract injuries and portal injuries because of excessive dissection to find out the absent gallbladder and ectopic gallbladder.
Case Report: A 40-year-old female attended surgical outdoor with complain of pain right hypochondrium and dyspepsia since last four years patient followed-up with USG abdomen which was suggestive of chronic cholecystitis with cholelithiasis, and common bile duct (CBD) was normal in diameter on the basis of clinical symptoms and USG findings patient admitted and planned for laparoscopic cholecystectomy. On laparoscopy findings were:
  1. Omentum and colonic loops were densely adherent to the inferior surface of liver
  2. After removing the adhesions, exploration done up to the porta but gallbladder could not be visualized.
  3. Further exploration was done to rule out the ectopic gallbladder but gallbladder could not be visualized at those sites also.
  4. CBD was normal in diameter.
  5. Procedure was terminated at this stage and decided to do post-operative MRCP in spite to go with open conversion to prevent iatrogenic bile duct injuries.
On postoperative day-1 patient was sent for MRCP with MRI abdomen.
MRCP findings were:
Gallbladder and cystic duct were not visualized. CBD was normal in caliber. Liver and pancreas were normal. Hence the diagnosis of agenesis was made.
Conclusion: Agenesis of gallbladder is an unusual anomaly in which about 23% presents as biliary disease. It is sometimes associated with anomalies of other system also and seems to be familiar inheritance. These patient frequently undergone surgery because of misinterpreted reports of USG abdomen, ERCP and CT abdomen. So, in cases with ultrasonographic diagnosis of scleroatrophic or non-visualization or suspicious of ectopic gallbladder and absence of wall echo shadow (WES) triad or double arc shadow, when non-visualization of gallbladder is present during laparoscopy or open exploration intraoperative cholangiogram, intraoperative ultrasound and postoperative MRCP or Endoscopic ultrasound (EUS) can help in the diagnosis of agenesis or ectopic gallbladder.

Keywords: Agenesis of gallbladder, Congenital, Absent gallbladder


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Author Contributions
Atul Kumar Mittal – Substantial contributions to conception and design, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Dhananjay Saxena – Substantial contributions to conception and design, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Raju Kadam – Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Prashant Garg – Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Jeevan Kankaria – Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Rajkamal Jenaw – Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
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The corresponding author is the guarantor of submission.
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Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Atul Kumar Mittal et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.