[Agenesis of the gallbladder]

Agenesis of the gallbladder, first described in 1701, is a rare, congenital malformation with an incidence of 0.01% to 0.04%. The condition can be associated with other and multiple anomalies. The diagnosis can be a random discovery during an abdominal operation or at autopsy, or an astonishing perioperative finding in a patient presenting with symptoms compatible with gallstone disease.

We present a young man with symptoms interpreted as related to gallstones. The preoperative ultrasound was misaprehended, describing a small, shrunken gallbladder filled with stones.

At laparoscopy we found no gallbladder, but a small accumulation of connective tissue and a cord-like structure believed to be the cystic duct. Attempts to cannulate this structure failed. Postoperative endoscopic retrograde cholangiography (ERC) showed normal intra- and extrahepatic biliary ducts, but no gallbladder or cystic duct. Five years after the laparoscopy the patient still experiences attacks of pain located to the right hypogastric area.

Though agenesis of the gallbladder is a rare condition, surgeons and radiologists should be aware of it. Uncertain ultrasound pictures should be supplied by more advanced CT or MR techniques to avoid unnecessary operations searching for an absent gallbladder.