Agenesis of the gallbladder revisited laparoscopically

Area of Science:

• Gastroenterology
• Surgical Innovation
• Embryology

Background:

• Gallbladder agenesis is a rare congenital condition with a reported necropsy incidence of 0.016%.
• Diagnosing gallbladder agenesis can be challenging, often indicated by symptoms mimicking gallstones and false-positive ultrasound findings.
• Laparoscopic cholecystectomy for suspected gallbladder disease can be complicated by the unexpected absence of the gallbladder.

Observation:

• This report details a case of gallbladder agenesis encountered during a laparoscopic cholecystectomy.
• Exploration revealed an abnormal embryological presentation: a patent cystic duct alongside an agenetic gallbladder.
• This represents the first documented case of gallbladder agenesis with a patent cystic duct and the first laparoscopic discovery of an absent gallbladder.

Findings:

• The patient presented with gallbladder-like symptoms and an abnormal ultrasound, necessitating surgical exploration.
• Standard surgical procedures were adapted to manage the absence of the gallbladder and identify potential ectopic locations.
• Intraoperative cholangiography confirmed the presence of a patent cystic duct, despite the absence of the gallbladder itself.

Implications:

• This case expands the understanding of gallbladder agenesis, challenging previous assumptions about the concurrent absence of the cystic duct.
• It underscores the importance of thorough intraoperative exploration and cholangiography in cases of suspected gallbladder agenesis during laparoscopic surgery.
• The findings contribute to the embryological understanding of biliary tract development and have implications for surgical planning and diagnostic accuracy.