Desiree Raygor, MD, Ruchir Puri, MD. University of Florida Health Jacksonville
Cholecystectomy is one of the commonest operations in general surgery . Occasionally chronic cholecystitis can lead to a small contracted gallbladder. This diagnosis can be misleading as it may represent congenital agenesis of the gallbladder . A 28-year-old female with a past history of pancreatitis presented with a three day history of right upper quadrant pain associated with nausea and vomiting. Upon exam she exhibited tenderness in the right upper quadrant. Her leukocyte count and liver function tests were within normal limits. Ultrasound revealed a poorly visualized, contracted gallbladder without stones and a dilated common bile duct (CBD). Cholescintigraphy revealed non visualization of the gallbladder after two hours, which was suggestive of acute cholecystitis. Decision was made to proceed with a laparoscopic cholecystectomy. The abdomen was entered by an open Hasson technique and standard trocar placement for a cholecystectomy was performed. On initial inspection, the gallbladder was not readily visible. A structure appearing to be the CBD was present and was mobilized circumferentially (Figure 1). A 19 gauge butterfly cannula was utilized and multiple cholangiographic images were obtained (Figure 2). No cystic duct or gallbladder was identified which was suggestive of congenital agenesis of the gallbladder. The patient did well postoperatively, and was discharged home on postoperative day two. The patient’s symptoms resolved and she continues to be pain free one month postoperatively.
Congenital agenesis of the gall bladder is a rare disorder. A high index of suspicion is required especially in the setting of a small contracted gall bladder. If preoperative imaging is inconclusive then diagnostic laparoscopy should be the next step. Cholangiogram should be performed routinely to confirm the diagnosis and to rule out an ectopic gall bladder. Conversion to open does not offer any distinct advantage, and laparotomy should be avoided if possible given its associated morbidity.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87336
Program Number: P138
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster