Clinical Cholecystitis in the Absence of the Gallbladder

Area of Science:

• Gastroenterology
• Surgical Innovation
• Medical Diagnostics

Background:

• Congenital absence of the gallbladder (CAG) is a rare anomaly with an incidence of 13-65 per 100,000 live births.
• It results from the failure of gallbladder and cystic duct budding from the common bile duct during embryonic development.
• Most patients with CAG are asymptomatic, but symptomatic cases can mimic biliary colic, dyspepsia, or jaundice.

Observation:

• A 27-year-old female presented with acute right upper quadrant abdominal pain.
• Initial ultrasound suggested a contracted gallbladder with stones.
• Hepatobiliary iminodiacetic acid scan showed non-visualization of the gallbladder, indicating potential cystic duct obstruction.

Findings:

• Laparoscopic cholecystectomy was aborted due to inability to visualize the gallbladder.
• Post-operative magnetic resonant cholangiopancreatography confirmed the diagnosis of congenital absence of the gallbladder.
• This case underscores the diagnostic difficulties in symptomatic CAG, especially when initial imaging is equivocal.

Implications:

• Accurate diagnosis of CAG is crucial for appropriate patient management and to avoid unnecessary surgical interventions.
• Advanced imaging techniques like MRCP are vital for confirming CAG when standard ultrasonography and HIDA scans are inconclusive.
• This case contributes to the understanding of symptomatic presentations and diagnostic pathways for this rare congenital anomaly.