Gall Bladder Agenesis: A Rare Embryonic Cause of Recurrent Biliary Colic.
Female; Humans; Young Adult; Recurrence; Rare Diseases; Gallbladder/*abnormalities; *Congenital Abnormalities; Biliary Tract Diseases/*etiology; Colic/*etiology
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.
Rajkumar Aarthi; Piya Albina
The American journal of case reports
2017
2017-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.12659/ajcr.903176" target="_blank" rel="noreferrer noopener">10.12659/ajcr.903176</a>
Gallbladder duplication and laparoscopic management.
*Laparoscopy; Adult; Cholangiopancreatography; Cholecystography; Endoscopic Retrograde; Female; Gallbladder/*abnormalities; Humans
Gallbladder duplication can present a significant challenge to the laparoscopic surgeon, primarily due to difficulties with diagnosis and recognition. Previous reports of attempted laparoscopic cholecystectomy in patients with gallbladder duplication resulted in incomplete or staged multiple procedures. The case report of a 35-year-old woman with successful laparoscopic management of symptomatic gallbladder duplication is described, emphasizing several important considerations. Preoperatively when evaluating radiologic studies a high index of suspicion is necessary in interpreting atypical findings. To further evaluate these abnormalities, liberal use of preoperative ERCP is helpful, and specific endoscopic techniques may be necessary as well. Intraoperatively, the findings may be confusing, and cholangiography can help clarify ductular anomalies, especially if the gallbladder duplication is contained within a common serosal coat. Missing a second gallbladder can result in persistent symptoms postoperatively necessitating further surgery. Laparoscopic cholecystectomy in the management of gallbladder duplication can be safely done and an awareness is necessary to avoid complications or multiple procedures.
Horattas M C
Journal of laparoendoscopic & advanced surgical techniques. Part A
1998
1998-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1089/lap.1998.8.231" target="_blank" rel="noreferrer noopener">10.1089/lap.1998.8.231</a>