Agenesis of the gallbladder

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 di

/pdf/agenesis-of-the-gallbladder-role-of-clinical-suspicion-and-2zs8kyegiy.pdf

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

BACKGROUND Gallbladder agenesis (GA) is an extremely rare anatomic anomaly with a reported incidence of less than 0.5%. It is usually asymptomatic, but can present with features of biliary colic and cholecystitis. We present here a case of GA in a patient with recurrent biliary colic.  CASE REPORT A 24-year-old African American woman presented with recurrent episodes of right upper-quadrant abdominal pain. During her first episode, she was found to have elevated transaminases and clinical features of cholecystitis, but ultrasound did not visualize a gallbladder and she was discharged with a diagnosis of biliary colic. She returned within a week with worsening liver enzymes, severe pain, and vomiting. A hepatobiliary iminodiacetic acid (HIDA) scan was done, which again did not show the gall bladder. On clinical suspicion of acute cholecystitis, she underwent laparoscopic surgery. Intraoperatively, the gall bladder fossa was empty and a diagnosis of gall bladder agenesis was made. She presented a third time with similar complaints and magnetic resonance cholangiopancreatography (MRCP) was done, which showed normal biliary tract anatomy and absent gall bladder. A diagnosis of sphincter of Oddi dysfunction was made and she was discharged on antispasmodics. CONCLUSIONS Diagnosing GA is challenging. The rarity of this entity combined with classic clinical features of cholecystitis and non-visualization of the gall bladder on routine investigation prompts unnecessary surgical intervention. Awareness of this condition, along with use of better imaging modalities like preoperative MRCP, can aide physicians to appropriately manage this uncommon clinical condition.

/pdf/gall-bladder-agenesis-a-rare-embryonic-cause-of-recurrent-1y8yd1cdch.pdf

Gall Bladder Agenesis: A Rare Embryonic Cause of Recurrent Biliary Colic.

A 4 yr old, spayed female domestic shorthair was referred with a 2 mo history of weight loss, anorexia, and diarrhea. Skin fragility was noted on presentation and a large skin tear measuring 5 cm × 5 cm was obvious over the dorsal cervical region. The patient was previously treated with short-term prednisone that was discontinued 6 wk before presentation. Initial diagnostics (complete blood count and biochemistry) did not indicate an endocrine disorder, the most common cause of acquired feline skin fragility. Necropsy revealed diffuse histoplasmosis (most significantly affecting the skin), epidermal atrophy, dermal collagen separation, and infiltration in the dermis and subcutis by inflammatory cells containing yeast organisms consistent with Histoplasma spp. Infiltrative fungal infection should be considered as a potential cause of acquired feline skin fragility.

Disseminated Histoplasmosis Accompanied by Cutaneous Fragility in a Cat

We report here on a case of intraductal papillary mucinous neoplasm (IPMN) of the bile duct, associated with gallbladder agenesis. A 65-year-old woman was admitted to the hospital with epigastric pain, anorexia, and nausea. Abdominal computed tomography scan and magnetic resonance imaging showed a 5 × 2.5 cm lobulated cystic lesion in the lateral lobe of the liver. The gallbladder was not seen on both imaging modalities. Endoscopic retrograde cholangiopancreatography suggested the diagnosis of biliary IPMN due to abundant mucin that protruded from the papilla and the lobulated cystic lesion. Laparoscopic wedge resection of the liver was performed. The final pathology was consistent with biliary IPMN. The specimen showed multifocal high-grade dysplasia with negative resection margins. The patient experienced no postoperative complications and was discharged 5 days after the operation.

Intrahepatic biliary intraductal papillary mucinous neoplasm with gallbladder agenesis: case report.

Gallbladder agenesis (GA) is a rare congenital anomaly of the biliary system often associated with other congenital abnormalities. Patients become symptomatic in 23% of cases. GA is often misinterpreted as other diseases, therefore, leading to unnecessary surgery. We report a case of congenital GA associated to cystic duct absence and a biliary tract abnormality diagnosed by Magnetic Resonance with Cholangiopancreatography.

/pdf/gallbladder-agenesis-and-cystic-duct-absence-in-an-adult-4ihqcjt8v5.pdf

Gallbladder agenesis and cystic duct absence in an adult patient diagnosed by magnetic resonance cholangiography: report of a case and review of the literature.

Giovanna Calabrese

Papers

Gallbladder agenesis and cystic duct absence in an adult patient diagnosed by magnetic resonance cholangiography: report of a case and review of the literature.