P Ripa, MD, M Reyes, MD, C Jaurrieta, MD. Tec de Monterrey Hospital San Jose.
Introduction: Agenesis of gallbladder is a very rare congenital abnormality that usually has no characteristic symptomatology and maybe associated to other anatomical malformations. Many of these patients develop a typical symptomatology of biliary colic leading the patient and the surgeon to the operating room. When surgical decision is taken it is better to remain at the level of a diagnostic laparoscopy because further surgical investigation may lead to detrimental biliary tract injuries.
Methods: A 46-year-old man presented with a 1 month history of right upper quadrant pain radiating to the right scapula. Ultrasonography revealed cholelithiasis, gallbladder wall thickening, and a dilated common bile duct.
Results: The patient went to the operating room for a laparoscopic cholecystectomy, but during the laparoscopy the identification of the gallbladder was unsuccessful. The common bile duct (CBD) was identified and found dilated; the gallbladder and cystic duct were inexistent.
The CBD was drained and a T-tube was placed during the same procedure. An intraoperative cholangiogram through the T-tube was done with no filling defects and free flow of contrast into the duodenum.
Conclusion: The incidence of agenesis of the gallbladder is between 0.01% and 0.04%, or 1 in 6,000 live births. Encountering gallbladder agenesis during an operation represents a dilemma since there is no consensus for an adequate treatment when the patient is symptomatic; this prompts the conversion to an open procedure for many surgeons since some physicians have emphasized the need for a thorough surgical exploration.
Key words: Gallbladder; Agenesis of; Congenital abnormalities; Cholecystectomy.