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Coronal views of computed tomography scan of abdomen and pelvis with contrast showing a small 9-mm structure in the gallbladder fossa likely related to gallbladder agenesis with no biliary obstruction and normal hepatic anatomy.
Source publication
We present the case of a 24-year-old woman with morbid obesity who came to the emergency department with right upper quadrant abdominal pain associated with nausea and vomiting. Her workup included a right upper quadrant ultrasound suggestive of a small gallbladder with cholelithiasis without sonographic evidence of acute cholecystitis. She underwe...
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Introduction and importance:
Gallbladder agenesis (GA) is a rare congenital anomaly. It results from failure of the formation of gallbladder primordium from the bile duct. This cohort of patients can present with symptoms of biliary colic and get misdiagnosed as cholecystitis or cholelithiasis.
Case presentation:
Here we discuss a case of gallbl...
Citations
... 6 The diagnosis of gallbladder agenesis can be challenging, and advanced imaging such as CT cholangiography and magnetic resonance cholangiopancreatography (MRCP) are needed to diagnose gallbladder agenesis in humans. [7][8][9][10] In veterinary medicine, CT cholangiography is a useful diagnostic tool for detecting absence of the gallbladder in dogs. 2 To the best of our knowledge, this is the first case report to describe the clinical and surgical findings and postoperative CT cholangiography findings from a cat showing bile duct perforation secondary to choledocholithiasis with gallbladder agenesis. year-old neutered male domestic shorthair cat was presented with a 1-week history of anorexia, vomiting and lethargy. ...
Case summary An 8-year-old neutered male domestic shorthair cat was presented for further investigation of anorexia, vomiting and lethargy. Abdominal ultrasonography and contrast-enhanced CT revealed choledocholithiasis with suspected bacterial peritonitis and non-visualisation of the gallbladder. During surgery, the common bile duct was noted to be perforated, and a cholelith was found in the abdominal cavity. No gallbladder was confirmed during surgery. Three months postoperatively, the cat underwent CT cholangiography and absence of the gallbladder with a vestigial duplicated gallbladder was diagnosed.
Relevance and novel information Gallbladder agenesis is extremely rare in cats, with only one previous report, but several dogs have been diagnosed based on CT cholangiography and laparoscopy. This report describes gallbladder agenesis concurrent with choledocholithiasis in an adult cat and represents the first report of CT cholangiography in a cat with gallbladder agenesis.
... 6 The diagnosis of gallbladder agenesis can be challenging, and advanced imaging such as CT cholangiography and magnetic resonance cholangiopancreatography (MRCP) are needed to diagnose gallbladder agenesis in humans. [7][8][9][10] In veterinary medicine, CT cholangiography is a useful diagnostic tool for detecting absence of the gallbladder in dogs. 2 To the best of our knowledge, this is the first case report to describe the clinical and surgical findings and postoperative CT cholangiography findings from a cat showing bile duct perforation secondary to choledocholithiasis with gallbladder agenesis. year-old neutered male domestic shorthair cat was presented with a 1-week history of anorexia, vomiting and lethargy. ...
Case summary
An 8-year-old neutered male domestic shorthair cat was presented for further investigation of anorexia, vomiting and lethargy. Abdominal ultrasonography and contrast-enhanced CT revealed choledocholithiasis with suspected bacterial peritonitis and non-visualisation of the gallbladder. During surgery, the common bile duct was noted to be perforated, and a cholelith was found in the abdominal cavity. No gallbladder was confirmed during surgery. Three months postoperatively, the cat underwent CT cholangiography and absence of the gallbladder with a vestigial duplicated gallbladder was diagnosed.
Relevance and novel information
Gallbladder agenesis is extremely rare in cats, with only one previous report, but several dogs have been diagnosed based on CT cholangiography and laparoscopy. This report describes gallbladder agenesis concurrent with choledocholithiasis in an adult cat and represents the first report of CT cholangiography in a cat with gallbladder agenesis.
... Gallbladder agenesis (GA) is a rare embryological anomaly with an incidence of 10-65 per 100,000 [1][2][3][4][5]. GA is associated with congenital anomalies and its occurrence is sporadic [3,4,[6][7][8]. ...
... GA is commonly misinterpreted as acute cholecystitis with cystic duct obstruction [9]. Most patients are asymptomatic but, in almost 50% of cases, they present right upper quadrant abdominal pain, dyspepsia, nausea, and vomiting [2,[10][11]. The mechanisms of biliary colic are unknown. ...
... No consensus is available on the appropriate management of GA and this reflects the heterogeneity of clinical scenarios and the variability of hospital facilities. For these reasons, many cases of GA have been described during the surgical procedure as an incidental finding [2][3][4]8,9]. Conversion to laparotomy and accurate investigation of the biliary anomaly for suspected gallbladder ectopy might be indicated although other colleagues discourage invasive and extensive surgical dissection with the aim of reducing exploration complications [13]. ...
Gallbladder agenesis (GA) is a rare embryological anomaly that presents acute cholecystitis like-symptoms. It is often an incidental finding diagnosed during surgery. We reported a case of GA in a patient who presented with dyspepsia and acute right upper abdomen pain with ultrasonographic signs of acute lithiasic cholecystitis. The preoperative assessment, according to first-level exams, is oriented to the diagnosis of acute lithiasic cholecystitis with atrophy and sclerosis. During laparoscopy, the proximal transverse colon was found strictly adherent to gallbladder fossa. The gallbladder was found to be absent. The surgical procedure consisted of lysis of multiple colo-hepatic adhesions. The diagnosis of congenital GA was made laparoscopically. The postoperative radiological images, based on CT and MR examinations, documented the diagnosis of GA with a biliary duct anatomical variant. The recovery was uneventful and the patient remained symptom-free for more than four years. GA is a clinical challenge that still poses diagnostic and therapeutic dilemmas. Although no diagnostic and therapeutic algorithm is accepted worldwide, due to heterogeneity of clinical scenarios and the variability in hospital facilities, surgeons have to be familiar with this rare entity, and conversion in laparotomy or unnecessary operative procedures should be avoided in the same operative setting.
... It is a rare congenital abnormality of the biliary tree with an incidence of <0.1% (range: 0.04%-0.1%) [2] and a female preponderance of 3:1 [1,3]. Literature evidence suggests that only 500 similar clinical cases have been reported [4]. ...
... When symptomatic, patients can present with signs of biliary colic, cholecystitis, or sometimes jaundice. Though there is no clear reason why some patients with gallbladder agenesis are symptomatic while others are not, a mechanism has been proposed whereby pain in gallbladder agenesis is due to biliary dyskinesia, Sphincter of Oddi dysfunction, or choledocholithiasis [2,3,8,9]. ...
... Several case reports published had a similar clinical presentation of upper abdominal pain resembling biliary colic, along with normal or elevated laboratory workup and unclear radiological signs [1][2][3][4][5]7,[8][9][10]. Other common presentations include nausea and/or vomiting (66%), fatty food intolerance (37.5%), dyspepsia, bloating, and occasional jaundice [7]. ...
Gallbladder agenesis is a rare anatomic congenital abnormality caused by the cystic bud failing to develop into the gallbladder. Gallbladder agenesis has a variable presentation, with 50% of patients presenting with symptoms mimicking biliary colic and 35% being incidentally discovered during surgery or autopsy, while another 15% can present with fatal fetal anomalies.
In this article, we present a case of gallbladder agenesis in a young woman who presented with biliary-colic-like symptoms suggesting cholecystitis. The gallbladder was not well visualized on ultrasonography, simulating chronic cholecystitis due to shrunken or contracted bladder. Further imaging with computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) helped in the successful diagnosis of gallbladder agenesis and helped prevent unnecessary surgical intervention.
Due to the lack of clinical suspicion diagnosing gallbladder agenesis preoperatively is still rare. Persistent symptoms are often associated with biliary colic pain leading to surgery. Conservative management consists of using antispasmodic medications. MRCP may be required to rule out gallbladder agenesis and avoid unnecessary surgery.
Gallbladder agenesis can present with symptoms similar to cholecystitis. If the gallbladder is not visualized well on the ultrasound, an additional radiological examination is required. Clinicians’ understanding of the condition helps to accurately diagnose the condition preoperatively using the appropriate investigations, thereby minimizing the operative risk to the patient.
... Gallbladder agenesis is a rare congenital abnormality with a reported incidence of 0.007-0.027% in surgical series and 0.04-0.13% in autopsy series [1]. This rare pathology presents predominantly in women (ratio 3:1), and results from either failure of the cystic bud to develop into the gallbladder and cystic duct in utero or failed recanalization of the cystic duct and gallbladder in the first month of life in utero [2]. Its presentation is variable; it may be asymptomatic in 35% of patients, later being discovered incidentally during abdominal surgery or at autopsy. ...
... Its presentation is variable; it may be asymptomatic in 35% of patients, later being discovered incidentally during abdominal surgery or at autopsy. It is present with other fatal fetal anomalies in 15%-16%, and is accompanied by typical symptoms in 50% [1,2]. The clinical symptoms suggestive of gallbladder agenesis are common to gallbladder diseases. ...
... The clinical symptoms suggestive of gallbladder agenesis are common to gallbladder diseases. They include right upper quadrant pain, fatty food intolerance, nausea, and jaundice, making it a convincing mimic of cholecystitis and biliary colic [2]. Routine preoperative ultrasound (US) can be misleading and showing a possible "scleroatrophic" gallbladder, and patients can be subject to unnecessary surgical procedures. ...
