• CT cholangiography
• Gallbladder agenesis
• bile duct perforation
• choledocholithiasis

Gallbladder agenesis (GA) is a very uncommon disorder of the biliary system. Diagnosis of GA can be difficult and may result in unnecessary procedures. In this case report, we will discuss our experience with an intraoperative accidental diagnosis of GA in a middle-aged woman that was effectively treated. Case Presentation. A 46-year-old woman presented with abdominal pain, nausea, vomiting, and intolerance to meals. Laparoscopic surgery was conducted based on sonographic imaging and a preliminary diagnosis of chronic cholecystitis. No gallbladder was seen during laparoscopy, and the patient was diagnosed as a case of GA. The laparoscopy was terminated, and the patient was referred for magnetic resonance cholangiopancreatography (MRCP) to confirm the diagnosis. Finally, endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy were performed to alleviate symptoms. After one year of follow-up, the patient's overall condition is satisfactory and symptom-free.

Our case exemplifies this common blunder. Therefore, we are reporting a case of GA discovered intraoperatively to increase surgeons' awareness and preparedness for this possible differential diagnosis and minimize unnecessary operational intervention.

Gallbladder agenesis is an extremely rare congenital condition in which most patients will remain asymptomatic; nonetheless, a small subset of patients will mimic biliary, urinary, or gastrointestinal disorders. As a result, if these patients are unaware of their condition, an ultrasound may be needed when they present with right upper abdominal pain, which can be misleading or inconclusive, putting the surgeon and the medical team in a diagnostic and intraoperative dilemma.

We present the case of a 36-year-old woman with a history of ventricular septal defect and cleft palate. She presented with abdominal pain to the emergency department. After an ultrasound, cholecystitis was misdiagnosed, and, unfortunately, the medical team did not realize this mistake. As a result, surgery was decided. After additional tests, gallbladder agenesis was diagnosed, and the patient fully recovered.

Congenital absence of the gallbladder can often pose a dilemma to surgeons when it is diagnosed during surgery. Preoperative diagnosis is highly challenging as it can mimic other pathologies; therefore, the medical team needs to keep this pathology on their list of differential diagnoses to avoid dangerous procedures.

Congenital absence of the gallbladder can often pose a dilemma to surgeons when it is diagnosed during laparoscopic cholecystectomy. Since preoperative diagnosis is challenging, communication between radiologists and surgeons is critical in order to provide proper care for any patient.

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Misdiagnosis can occur and it's our duty as physicians to learn from these mistakes.

• cholecystectomy
• ectopic gallbladder
• left hepatic vein
• left lobe agenesis
• left portal vein

Gallbladder agenesis (GA) is a rare congenital malformation characterized by the absence of the gallbladder and cystic duct due to an anomaly in the embryonic development. It is commonly associated with other congenital abnormalities, and the isolated form is extremely rare. Its clinical presentation is variable. Actually, GA is more often incidentally diagnosed. Magnetic resonance cholangiopancreatography (MRCP) is considered to be the diagnosis method of choice since it avoids unnecessary and risky surgery in symptomatic patients. Here we report the case of a radiologically incidentally discovered gallbladder agenesis in a 68-year-old patient.

• Gallbladder agenesis
• case report
• magnetic resonance cholangiopancreatography
• ultrasound

• fetal diseases
• gallbladder
• hernia, umbilical
• methimazole
• vitelline duct

• Antithyroid Agents/adverse effects
• Child
• Female
• Fetal Diseases
• Gallbladder/diagnostic imaging
• Humans
• Hyperthyroidism
• Infant
• Infant, Newborn
• Male
• Methimazole/adverse effects
• Pregnancy

Agenesis of the gallbladder and cystic duct represents one of the rarest anomalies of the biliary system, with a reported incidence of 0.007% to 0.027%. Almost half of the patients develop common duct stones and 23% of them manifest signs and symptoms that mimic biliary colic. We present the case of a woman presenting with symptoms of biliary colic. Based on the clinical findings and after abdominal ultrasonography, which showed hyperechoic material in the gallbladder fossa, a laparoscopic cholecystectomy was planned. Laparoscopy failed to reveal either gallbladder or cystic duct. The procedure was continued to further search for ectopic sites of gallbladder. A condition of gallbladder agenesis was hypothesized and the procedure was aborted without dissection of hepatic pedicle or conversion to laparotomy. Agenesis of gallbladder and cystic duct was confirmed via pos-operative magnetic resonance cholangiopancreatography. We report our experience with regard to the challenges associated with the diagnosis and management, and a brief review of the literature of this rare pathology.

• Congenital abnormalities of the biliary tract
• Gallbladder agenesis
• Laparoscopic cholecystectomy

• Ectopic gall bladder
• Gallbladder agenesis
• Hepatobiliary scintigraphy

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Agenesis of the gall bladder is extremely rare, A high index of suspicion is mandatory for diagnosis.

Agenesis of gallbladder is a rare congenital anomaly of biliary tree that may be associated with other biliary and extra biliary congenital anomalies.

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.

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.

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.

• Agenesis of gall bladder
• Conversion to open
• Gallbladder diseases
• Laparoscopic cholecystectomy
• Ultrasound diagnosis
• Unnecessary surgery

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.

• Biliary colic
• Conservative management
• Gallbladder agenesis
• Magnetic resonance cholangiopancreatography

• agenesis
• atrial septal defect
• cholecyst
• congenital

• Adult
• Cholangiopancreatography, Magnetic Resonance
• Cystic Duct/abnormalities
• Diagnosis, Differential
• Female
• Gallbladder/abnormalities
• Humans
• Laparoscopy
• Obesity, Morbid
• Pain Management

• Adenocarcinoma, Mucinous/complications
• Adenocarcinoma, Mucinous/diagnosis
• Adenocarcinoma, Mucinous/surgery
• Aged
• Bile Duct Neoplasms/complications
• Bile Duct Neoplasms/diagnosis
• Bile Duct Neoplasms/surgery
• Bile Ducts, Intrahepatic
• Cholangiopancreatography, Endoscopic Retrograde
• Cholangiopancreatography, Magnetic Resonance
• Female
• Gallbladder/abnormalities
• Gallbladder Diseases/complications
• Gallbladder Diseases/congenital
• Gallbladder Diseases/surgery
• Hepatectomy/methods
• Humans
• Laparoscopy/methods
• Tomography, X-Ray Computed

• Biliary colic
• Conservative management
• Gallbladder agenesis
• Magnetic resonance cholangiopancreatography
• Sphincterotomy

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.

• Abnormalities, Multiple/diagnosis
• Aged, 80 and over
• Choledocholithiasis/complications
• Choledocholithiasis/diagnosis
• Cystic Duct/abnormalities
• Gallbladder/abnormalities
• Humans
• Laparoscopy
• Male

Isolated agenesis of the gallbladder is a rare anomaly, often asymptomatic. However, one patient out of four presented with right upper abdominal pain, nausea, and fatty food intolerance. The condition is frequently mistaken with an excluded or sclero-atrophic gallbladder, regardless of the imaging modality used. Consequently, AG often leads to unnecessary and potentially dangerous laparoscopic surgery as described in a few case reports over the last 10 years. The aim of this study is to clarify the diagnostic and therapeutic approach of this unusual pathology. Two cases seen in our institutions were retrospectively reviewed, together with a review of the American and European literature. During laparoscopy, the absence of normal anatomical structures and the impossibility of pulling on the gallbladder to expose and dissect the triangle of Callot increases the risk of iatrogenic injury to biliary or portal structures. Depending on the experiment of the surgeon in laparoscopic procedure, this has to be taken into account to decide a conversion to laparotomy. A high index of suspicion is necessary when interpreting the radiological images. In case of doubt, a MRI-cholangiography is mandatory. Because of possible inherited transmission, relatives with a history of biliary symptoms should be investigated.

• Gallbladder
• Laparoscopy
• Pathology

• Abdominal Pain/pathology
• Adult
• Aged
• Diagnostic Errors
• Gallbladder/abnormalities
• Humans
• Laparoscopy
• Male

• Digestive System Abnormalities/diagnosis
• Digestive System Abnormalities/embryology
• Digestive System Abnormalities/therapy
• Gallbladder/abnormalities
• Humans