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Sun HJ, Ge F, Si Y, Wang Z, Sun HB. Importance of accurate diagnosis of congenital agenesis of the gallbladder from atypical gallbladder stone presentations: A case report. World J Clin Cases 2023; 11:6864-6870. [PMID: 37901002 PMCID: PMC10600836 DOI: 10.12998/wjcc.v11.i28.6864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/10/2023] [Accepted: 08/21/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Congenital agenesis of the gallbladder (CAGB) is a rare condition often misdiagnosed as cholecystolithiasis, leading to unnecessary surgeries. Accurate diagnosis and surgical exploration are crucial in patients with suspected CAGB or atypical gallbladder stone symptoms. Preoperative imaging, such as magnetic resonance cholangiopancreatography (MRCP), plays a vital role in confirming the diagnosis. Careful intraoperative dissection is necessary to avoid iatrogenic injuries and misdiagnosis. Multidisciplinary consultations and collaboration, along with the use of various diagnostic methods, can minimize associated risks. CASE SUMMARY We present the case of a 34-year-old female with suspected gallbladder stones, ultimately diagnosed with CAGB through surgical exploration. The patient underwent laparoscopic examination followed by open exploratory surgery, which confirmed absence of the gallbladder. Subsequent imaging studies supported the diagnosis. The patient received appropriate postoperative care and experienced a successful recovery. CONCLUSION This case highlights the rarity of CAGB and the importance of considering this condition in the differential diagnosis of patients with gallbladder stone symptoms. Accurate diagnosis using preoperative imaging, such as MRCP, is crucial to prevent unnecessary surgeries. Surgeons should exercise caution and conduct meticulous dissection during surgery to avoid iatrogenic injuries and ensure accurate diagnosis. Multidisciplinary collaboration and utilization of various diagnostic methods are essential to minimize the risk of misdiagnosis. Selection of the optimal treatment strategy should prioritize minimizing trauma and maintaining open communication with the patient and their family members.
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Affiliation(s)
- Hai-Jian Sun
- Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| | - Fei Ge
- Department of Gastroenterology, Haian Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nantong 226600, Jiangsu Province, China
| | - Yue Si
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou 225000, Jiangsu Province, China
- Jiangsu Key Laboratory of Experimental & Translational Non-Coding RNA Research Yangzhou, Yangzhou University, Yangzhou 225000, Jiangsu Province, China
| | - Zheng Wang
- Department of Endocrinology, The Affiliated Hospital of Yangzhou University, Yangzhou 225000, Jiangsu Province, China
| | - Hai-Bo Sun
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou 225000, Jiangsu Province, China
- Jiangsu Key Laboratory of Experimental & Translational Non-Coding RNA Research Yangzhou, Yangzhou University, Yangzhou 225000, Jiangsu Province, China
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Pinto MYP, Neelankavil S. Gallbladder agenesis diagnosed during pregnancy- Case report and a literature review. Int J Surg Case Rep 2023; 105:108019. [PMID: 36966713 PMCID: PMC10073876 DOI: 10.1016/j.ijscr.2023.108019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/10/2023] [Accepted: 03/17/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Gallbladder agenesis (GA) is a rare congenital anomaly. It results from failure of the formation of gallbladder primordium from the bile duct. This cohort of patients can present with symptoms of biliary colic and get misdiagnosed as cholecystitis or cholelithiasis. CASE PRESENTATION Here we discuss a case of gallbladder agenesis presenting with symptoms of typical biliary colics in a 31 year old female patient during her second pregnancy. She underwent two ultrasound scans (USS) which couldn't visualise a gallbladder. She eventually had a magnetic resonance cholangiopancreatography (MRCP) which confirmed the absence of a gallbladder. CLINICAL DISCUSSION Diagnosis of gallbladder agenesis in adult life poses a diagnostic dilemma. This is partly due to misinterpretation of USS results. Still, some patients get diagnosed with this condition during attempted laparoscopic cholecystectomy. However, with a thorough understanding of the condition, unnecessary surgeries can be prevented. CONCLUSION Misdiagnosis is possible and can lead to unnecessary surgeries. Appropriate and timely investigations can diagnose GA. One should have high index of suspicion when an USS result shows a non-visualisation of the gallbladder, contracted or a shrunken gallbladder. It is prudent to further investigate this cohort of patients to rule out gallbladder agenesis.
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Neubeck K, Neelankavil S. Gallbladder agenesis: a rare cause of right upper quadrant pain. ANZ J Surg 2022; 93:1102-1103. [PMID: 36321250 DOI: 10.1111/ans.18137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
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Muacevic A, Adler JR. Preoperative Diagnosis of Gallbladder Agenesis: A Case Report. Cureus 2022; 14:e30753. [PMID: 36320796 PMCID: PMC9616560 DOI: 10.7759/cureus.30753] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 11/07/2022] Open
Abstract
Gallbladder agenesis (GA) is a rare congenital malformation with less than 500 reported cases. Often an incidental finding intraoperatively or in postmortem autopsies, the first reported case dates back to 1701. We discuss the case of a 21-year-old female presenting with classic biliary symptoms who, on imaging, failed to have a visualizable gallbladder. Initial ultrasound (US) reported a non-visualized gallbladder with gallbladder contraction as a possible explanation. More advanced imaging allowed for the preoperative diagnosis, thus preventing an unpleasant intraoperative surprise. As imaging techniques continue to advance, unnecessary operations can hopefully be avoided, albeit a difficult diagnosis to make.
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Kelly D, Moreno-Aguado B, Lamb V. Gallbladder Agenesis in a Dog: Clinicopathological, Histopathology, and Computed Tomography Findings. J Am Anim Hosp Assoc 2019; 55:e55602. [PMID: 31525090 DOI: 10.5326/jaaha-ms-6769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Three cases of gallbladder agenesis (GA) have been previously reported in the English-speaking veterinary literature. Affected dogs can be either asymptomatic or symptomatic with vomiting, retching, and anorexia previously reported. The previously reported cases and the dog in this report had marked elevations in alanine aminotransferase concentrations, and liver histopathology consistently showed bridging fibrosis and biliary hyperplasia. The condition is most often diagnosed in humans during exploratory surgery, which was also the case in the previous three dogs reported with GA. Computed tomography (CT) or MRI is now recommended for diagnosis of the condition in humans, and this is the first report of CT findings in an affected dog diagnosed without surgery. Bile stasis and cholangiohepatits have been proposed as secondary pathologies in both humans and dogs with GA, and histopathology and CT findings in this case support those theories.
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Affiliation(s)
- Darren Kelly
- From Southern Counties Veterinary Specialists, Hampshire, United Kingdom
| | | | - Valerie Lamb
- From Southern Counties Veterinary Specialists, Hampshire, United Kingdom
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Bahraini A, Odom JW, Talukder A. A case report of a patient with gallbladder agenesis resulting in a common bile duct injury. Int J Surg Case Rep 2018; 51:99-101. [PMID: 30149331 PMCID: PMC6111033 DOI: 10.1016/j.ijscr.2018.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/06/2018] [Accepted: 07/21/2018] [Indexed: 11/17/2022] Open
Abstract
Gallbladder agenesis can present with symptoms of biliary colic or cholecystitis. Imaging studies of a patient with gallbladder agenesis can be inconclusive. If operated on, the surgeon will be unable to visualize the gallbladder. In such cases, the procedure should be aborted, and further diagnostic testing should be done.
Introduction Congenital agenesis of the gallbladder is a rare embryological defect of the biliary system. While occurring equally in men and women, gallbladder agenesis is found clinically twice as often in women. Patients present with symptoms suggesting biliary colic. Abdominal ultrasound and cholecintigraphy or HIDA scan are usually inconclusive and, in some cases, may be read as positive for biliary colic. Patients can undergo surgery based on characteristics of pain. Presentation of case We report the case of a 60-year-old female presenting with symptoms of recurrent biliary colic and subsequently undergoing laparoscopic cholecystectomy after inconclusive workup. Discussion We offer a review of past reported cases as well as a new approach to such patients during the intraoperative period. An intraoperative decision should be made whether to continue and search for a possible ectopic gallbladder or investigate further with imaging studies. Conclusion Gallbladder agenesis is a rare clinical presentation that the surgeon must be aware of. With inconclusive studies, the surgeon should consider congenital absence of the gallbladder and pursue further imaging if the gallbladder cannot be localized during the intraoperative period.
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Affiliation(s)
- Anoosh Bahraini
- Department of Medicine, Medical College of Georgia, Augusta, USA.
| | - John W Odom
- Department of Medicine, Medical College of Georgia, Augusta, USA
| | - Asif Talukder
- Department of Medicine, Medical College of Georgia, Augusta, USA
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Al-Hakkak SMM. Agenesis of gall bladder in laparoscopic cholecystectomy-A case report. Int J Surg Case Rep 2017; 39:39-42. [PMID: 28802164 PMCID: PMC5552385 DOI: 10.1016/j.ijscr.2017.06.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 01/14/2023] Open
Abstract
Agenesis of the gall bladder is extremely rare, A high index of suspicion is mandatory for diagnosis. The awareness of physician, radiologist and the surgeons of the possibility of this condition and of the problems posed by it. The surgeon to attempt confirmation of diagnosis, when suspected, by nonoperative methods. Non-visualized gall bladder in laparoscopic cholecystectomy is challenging. No extensive dissection was needed or change to open method unless you sure that the gall bladder is present.
Introduction Agenesis of gallbladder is a rare congenital anomaly of biliary tree that may be associated with other biliary and extra biliary congenital anomalies. Case presentation A 43- year- old female presented with a 4 months history of upper abdominal pain associated with nausea and vomiting. It was associated with dyspeptic symptoms and become worse following ingestion of high-fat meal contents. Clinically, a differential of gall stone disease was considered. Ultrasonography of abdomen revealed a contracted gallbladder with multiple stones with normal wall thickness, so the fact of clinical diagnosis considering finding cholithiasis. She was submitted to laparoscopic exploration which revealed that the gall bladder was absent within gall bladder fossa. Discussion In this case, the differential of cholithiasis symptoms considered support by ultrasonography, symptomatic gall stones presented more than half of cases of gall bladder agenesis, Diagnosis of gall bladder disease usually done by ultrasound modality, it must be done by expert one. Awareness of this entity by clinicians, surgeons and radiologists are essential because many of these patients present with biliary symptoms and have unnecessary operations. Conclusion Agenesis of gallbladder should be kept in mind whenever the gall bladder was improperly visualized in routine imaging methods. Ultrasonography operated dependent we must not depend on single one or even multiple done by the same person. Avoid a needless surgical exploration, which might be risky. Non-visualized gall bladder during laparoscopic cholecystectomy is challenging should not convert to open unless sure that the gall bladder was present.
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Scobie JL, Bramhall SR. Congenital agenesis of the gallbladder: a UK case report. Oxf Med Case Reports 2016; 2016:omw040. [PMID: 29497543 PMCID: PMC5782472 DOI: 10.1093/omcr/omw040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 04/27/2016] [Accepted: 05/02/2016] [Indexed: 11/13/2022] Open
Abstract
Congenital absence of the gallbladder has a reported incidence between 0.013 and
0.075% (Singh et al., Congenital absence of the gallbladder. Surg
Radiol Anat 1999; 21: 221–4). With fewer than 500 cases reported in the literature,
it is a well-recognised yet rare embryological malformation. Gallbladder agenesis becomes
symptomatic in almost a quarter of cases mostly presenting as cholecystitis or
cholecystolithiasis. In this case report, a 24-year-old Caucasian male presented with
intermittent right-sided abdominal pain with no associated symptoms. On a background of no
past medical history, his pain was presumed to be biliary colic. The rarity of these case
reports shows that there is a lack of awareness of gallbladder agenesis when thinking of
differential diagnoses. There has also been no conclusive gold standard investigation
decided, upon which results are satisfactory enough to avoid surgery. Therefore, as in
this case report, this group of patients often undergo unnecessary operations as often the
condition is not considered and precise diagnosis pre-operatively is very difficult.
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Abstract
Gallbladder agenesis is a rare entity with an estimated incidence of 10-65 per 100,000. Females are more commonly affected (ratio 3:1), typically presenting in the 2nd or 3rd decade of life. Despite an absent gallbladder, half of patients present with symptoms similar to biliary colic, which is poorly understood. Clinicians should have a strong index of suspicion if nonvisualization is suggested by an ultrasound. HIDA scans are typically not helpful since nonvisualization of the gallbladder remains typical of cystic duct obstruction as well as of agenesis. While there are no specific guidelines for management of gallbladder agenesis, conservative management with smooth muscle relaxants is preferred. Sphincterotomy also has been reported in severe cases. Here, we report a case of a 21-year-old woman who presented with recurrent biliary colic and was diagnosed to have gallbladder agenesis on magnetic resonance cholangiopancreatography. A comparison with other cases and a review of the literature are presented.
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Affiliation(s)
- Pashtoon Murtaza Kasi
- International Scholars Program, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pa., USA
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Kwon AH, Yanagimoto H, Matsui Y, Imamura A. Agenesis of the Gallbladder With Hypoplastic Cystic Duct Diagnosed at Laparoscopy. Surg Laparosc Endosc Percutan Tech 2006; 16:251-4. [PMID: 16921307 DOI: 10.1097/00129689-200608000-00012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An 86-year-old man was admitted to our department with complaints of intermittent upper abdominal pain. Ultrasonography of the abdomen showed dilated extrahepatic bile ducts containing stones; however, the gallbladder was not clearly identified. Magnetic resonance cholangiopancreatography showed dilated extrahepatic ducts and choledocholithiasis without gallbladder visualization. The stone extraction was performed with endoscopic sphincterotomy. Three-dimensional images using spiral-computed tomography after intravenous-infusion cholangiography clearly demonstrated an obstruction of the cystic duct. The patient was scheduled for laparoscopic cholecystectomy. At laparoscopy, the gallbladder fossa was not identified on the undersurface of the liver. Despite a thorough examination of the intrahepatic (left-sided within the lesser omentum), retroperitoneal, retrohepatic (within the falciform ligament), retroduodenal, and retropancreatic areas using laparoscopic ultrasonography, the gallbladder was not found. After careful dissection of the hepatoduodenal ligament, the dilated extrahepatic bile duct and a 1-cm length of hypoplastic cystic duct were found. Gallbladder agenesis is usually accompanied by the lack of the cystic duct. The present case is the third report of gallbladder agenesis with a patent or hypoplastic cystic duct.
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Affiliation(s)
- A-Hon Kwon
- Department of Surgery, Kansai Medical University, Osaka, Japan.
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Abstract
Gallbladder agenesis is a rare congenital biliary anomaly that may be associated with other biliary and extrabiliary congenital anomalies. Awareness of this entity by clinicians and radiologists is essential because many of these patients present with biliary symptoms and have unnecessary operations. In the present article, the relative epidemiological, etiological (embryology and development), pathophysiological, diagnostic tools and pitfalls and management aspects of this rare anatomic anomaly are briefly discussed through review of the literature. Particular reference to the difficulty in preoperative diagnosis is highlighted. The importance of the possibility of preoperative diagnosis to avoid unnecessary surgery is stressed.
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Affiliation(s)
- Kamal E Bani-Hani
- Department of Surgery, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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12
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Singh G, Rao K, Ghosh SR, Chaudhry R. Congenital Absence of Gall Bladder. Med J Armed Forces India 2003; 59:152-3. [PMID: 27407494 DOI: 10.1016/s0377-1237(03)80067-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Gurjit Singh
- Commandant, Artificial Limb Centre, Pune - 411 040
| | - Kpk Rao
- Graded Specialist (Surgery), 160 Military Hospital, C/o 99 APO
| | - S R Ghosh
- Classified Specialist (Surgery and GI Surgery), Command Hospital (Central Command), Lucknow
| | - R Chaudhry
- Senior Advisor (Surgery and GI Surgery), Command Hospital (Northern Command), C/o, 56 APO
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