Agenesis of the gallbladder: lessons to learn

Area of Science:

• Gastroenterology
• Surgical Anatomy
• Diagnostic Imaging

Background:

• Congenital gallbladder agenesis is a rare anatomical variation.
• It often presents asymptomatically but can mimic gallbladder disease.
• Standard ultrasonography has limitations in diagnosing gallbladder agenesis.

Observation:

• A patient with suspected cholecystitis and a "shrunken gallbladder" on ultrasound underwent laparoscopy.
• The gallbladder was not identified intraoperatively, leading to procedure termination.
• Magnetic resonance cholangiopancreatography and endoscopic ultrasound confirmed gallbladder agenesis.

Findings:

• Laparoscopic nonvisualization of the gallbladder, without other biliary pathology, suggests agenesis.
• Advanced imaging modalities like MRCP and EUS accurately delineate biliary anatomy.
• Congenital absence of the gallbladder can be diagnosed non-invasively.

Implications:

• Laparoscopic nonvisualization does not necessitate conversion to open surgery for suspected agenesis.
• Noninvasive imaging prevents diagnostic laparotomy and associated morbidity.
• Accurate preoperative diagnosis of gallbladder agenesis improves surgical planning and patient outcomes.