Agenesis of gall bladder: Diagnosed before it is an unpleasant laparoscopic surprise-clinical case report and review

INTRODUCTION & BACKGROUND: Agenesis of gall bladder is a rare congenital anomaly and incidence is 0.007–0.0027%. Even though gall bladder is absent, clinical presentation of 50% cases, mimic biliary colic. This combined with inconclusive radiological findings leads to wrong preoperative diagnosis and patients are subjected to unnecessary surgery causing complications like injury to biliary tract. Except for few cases where a preoperative diagnosis of absent gall bladder was made in majority of cases, agenesis of the gallbladder is described as an incidental finding during surgery. The work has been reported in line with the SCARE criteria (Agha et al., 2018). CASE PRESENTATION: This article will share our experience about two cases who presented with complains of pain in right upper quadrant and USG examination revealed inconclusive reports as cholelethiasis with contracted or shrunken gall bladder in first case and in second case as cholelethiasis with non-visualisation of gall bladder. On further imaging with MR cholangiogram diagnosis of agenesis of gall bladder was made and unnecessary surgery was avoided. DISCUSSION: Ultrasound is the imaging technique of choice to assess the gallbladder; but difficulty arises when gallbladder is either contracted or atrophic. Magnetic cholangioresonance is a non-invasive modality which can describe anatomy of biliary apparatus. So Magnetic cholangiogram should be combined with inconclusive USG studies for gall bladder agenesis. CONCLUSION: With better imaging modalities, it has been possible to diagnose gallbladder agenesis before surgery. And so inconclusive US reports of gall bladder should be combined with MR imaging. In Perioperative scenario on suspicion of gall bladder agenesis present norm is to quit laparoscopy and resort to MR cholangiogram to reduce exploration complications.