Anesthesia & Clinical Research
Open Access
ISSN: 2155-6148
ISSN: 2155-6148
Puneet K Agarwal
All India Institute of Medical Sciences Bhopal, India
Scientific Tracks Abstracts: J Anesth Clin Res
Introduction: Gallbladder agenesis is a rare congenital abnormality of the biliary tract. The diagnosis is
usually made during surgery. It has been proven to be very difficult to make a correct preoperative diagnosis
of agenesis of the gallbladder in symptomatic patients. The purpose of this presentation is to share our
experience about a case of middle-aged lady who presented with symptoms of biliary colic. Ultrasound
examination revealed cholelethiasis with contracted gallbladder. On Contrast CT examination gallbladder
could not be visualized. On further imaging as MRCP diagnosis of gallbladder agenesis could be confirmed.
This helped in avoiding unnecessary surgery and patient was conservatively treated.
Clinical Case: A middle-years lady presented to surgical department with symptoms of right upper
abdominal pain and dyspepsia. On examination she was hemodynamically stable and there was no fever.
On examination abdomen was soft with negative Murphy’s sign and active peristalsis. Laboratory tests were
within normal limits. Ultrasound imaging revealed cholelethiasis with contracted gallbladder. Subsequently
the Contrast CT scan of abdomen was done which revealed non-visualization of gallbladder and cystic duct.
Further to confirm MR cholangiogram was done and the gallbladder and cystic duct were found to be absent
with rest of the extra hepatic biliary tree to be normal.
Conclusion: Agenesis of the gallbladder is a very rare condition and can create difficulties for surgical team
when diagnosed during Laparoscopic Cholecystectomy. With the development of better imaging modalities
it has been possible to diagnose gallbladder agenesis before surgery. Correct preoperative diagnosis can help
to avoid unnecessary surgeries and reduce exploration complications.
Discussion: It is estimated that 23% of patients with gallbladder agenesis present with symptoms of biliary
colic. Out of these patients, 90.1% will present colicky pain in the right hypochondrium, 66.3% with post
prandial nausea and vomiting, 37% with acid peptic symptoms and 27% CBD stones. These symptoms can
be attributed to the theory of biliary dyskinesia. It is well known that ultrasound is the imaging technique
of choice to assess the gallbladder; but difficulty in reporting arises when gallbladder is either contracted
or atrophic. WES ((Wall, Echo and Acoustic shadow) triad was described for diagnosis of gallstones. Some
ultrasound examinations performed on patients of agenesis of gallbladder can report cholelethiasis and
this can be explained owing to the fact that radiologist can misdiagnose the periportal tissue, subhepatic
peritoneal folds, duodenum or calcified hepatic lesions with the WES triad.
Puneet K Agarwal has completed his MBBS degree and Masters in Surgery (MS) from Jawaharlal Medical College, a reputed medical school affiliated to Aligarh Muslim University, Aligarh. Presently he is working as an Associate Professor in Department of Surgery in All India Institute of Medical Sciences Bhopal, an autonomous institute of national importance and affiliated to Government of India. He has published more than 25 articles in different journals.