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Chirurgia 2011 December;24(6):315-7

Copyright © 2012 EDIZIONI MINERVA MEDICA

language: English

Agenesis of the gallbladder and cystic duct: case report and review of the literature

Grasso E. 1, Cantarella S. 2, Politi A. 2, Samperisi L. 2, Guastella T. 2

1 Department of Surgery and Traumatology, La Carità Hospital, Locarno, Switzerland 2 Division of Emergency Surgery, University of Catania, Cannizzaro Hospital, Catania, Italy


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Agenesis of the gallbladder and cystic duct is a rare congenital malformation, usually asymptomatic. Since this abnormality was first described in 1701, several cases have been reported. Its presumed incidence rate is from 0.01% to 0.04% and a frequency of 0.016% at necroscopy. The preoperative diagnosis is extremely difficult and the absence of the gallbladder is often an intraoperative finding. Although ultrasonography is considered to have a high sensitivity, a small contracted gallbladder associated with stones and chronic cholecystitis, could be difficult to identify. We report the rare case of a 68-year-old white woman who had a history of sporadic colicky pains in the upper abdomen for 10 years, accompanied by nausea, vomiting and intolerance towards fatty foods, referred to our service, for an isolated gallbladder and cystic duct agenesis misdiagnosed preoperatively as lithiasic cholecystitis. Awareness of this entity by clinicians and radiologists is essential because many of these patients present biliary symptoms and have unnecessary operations. In conclusion, preoperative diagnosis of congenitally gallbladder agenesis is extremely difficult. This diagnosis will remain elusive unless CT or MR is routinely performed in cases of vague biliary symptoms, in the presence of positive sonographic findings, but this is rarely done. So, intraoperative cholangiography or intraoperative laparoscopic ultrasonography must be performed and the external hepatic bile duct must be carefully identified along its entire length in an attempt to localize the organ that is apparently absent during laparoscopic approach.

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