Central European Journal of Medicine * E-mail: drkaratepe@yahoo.com Agenesis of the gallbladder as a rare misdiagnosis Received 3 February 2008; Accepted 22 May 2008 Abstract: Anatomic anomalies of the biliary tract are not uncommon, but gallbladder and cystic duct agenesis is rare, with an incidence of 0.01% to 0.04% and a frequency of 0.016% at autopsy. It is usually asymptomatic and discovered incidentally. Although this congenital anomaly is infrequent, it may be encountered in clinical practice; thus, the surgeon should be aware of the associated problems. A correct preoperative diagnosis of this congenital anomaly is diffcult to establish because of the nonspecifc nature of the symptoms and the relative inaccuracy of the currently available diagnostic tests. Here we report a patient with a preoperative false diagnosis of cholelithiasis that was found on laparoscopy and open surgery to be agenesis of the gallbladder. © Versita Warsaw and Springer-Verlag Berlin Heidelberg. Keywords: Aganesis • Gallblader • Cystic duct Okmeydanı Training and Research Hospital, Department of General Surgery, Istanbul 34715, Turkey Oguzhan Karatepe * , Merih Altiok, Muharrem Battal, Gökhan Adas, Osman Bilgin Gülcicek, Ersin Acet, Servet Karahan Case Report 1. Introduction Gallbladder agenesis is an extremely rare embryologic abnormality and is often encountered during cholecystectomy [1-4]. Even if biliary agenesis is diagnosed during surgery, the surgeon may not be aware of the accompanying pathologic conditions, and a delay in the proper patient guidance may result. Biliary agenesis could be misdiagnosed radiologically as cystic duct obstruction or acute cholecystitis or chronic cholecystitis in patients in whom the gallbladder is not seen during ultrasonographic examination, since shrunken and scarred gallbladder tissue is diffcult to visualize in chronic infammatory conditions [4,5]. In this report, we describe such a case of gallbladder agenesis that was diagnosed both at surgery and during post- surgical MRI scanning after a prior false diagnosis of cholelithiasis and chronic cholecystitis. 2. Case report A 35-year-old woman was admitted to our department having had intermittent upper abdominal pain for 2 months. Her blood pressure was 160/80 mm Hg, and her body temperature was 36.5ºC. Her abdomen was soft and fat, with tenderness in the upper quadrants. Hematologic laboratory, blood chemistry, and renal function tests were unremarkable. Serum levels of aspartate aminotransferase, alanine aminotransferase, total bilirubin, g-glutamyltransferase, and alkaline phosphatase, which indicate liver function, were not elevated. An abdominal ultrasound showed an area with hyperechoic boundaries, which was interpreted as an infamed gallbladder with thick, irregular walls and lithiasis, and she was referred for laparoscopic cholecystectomy. Surgery was performed, but with the laparoscopic approach, we failed to detect the gallbladder in its anatomic position, and the anatomy of the biliary tract was also unclear (Fig. 1B). Despite a thorough intraoperative ultrasonographic examination of the intrahepatic (left-sided areas within the lesser omentum), retroperitoneal, retrohepatic (within the falciform ligament), retroduodenal, and retropancreatic areas, the gallbladder was not found. We then decided to convert the procedure to an open laparotomy, but the gallbladder was again not detected in any of the possible ectopic positions. A white scar extended through the surface of the right lobe of the liver (Fig. 1A). The patient was diagnosed as having agenesis of the gallbladder. The operation was completed without resection. Her postoperative course was uneventful. Magnetic Cent. Eur. J. Med. • 4(1) • 2009 • 128-130 DOI: 10.2478/s11536-008-0043-9 128 Unauthenticated Download Date | 3/3/20 9:12 AM