Surgeons

Biography

Biography: Puneet K Agarwal

Abstract

Introduction: Gallbladder agenesis is a rare congenital abnormality of the biliary tract. Th e diagnosis is usually made during surgery. It has been proven to be very diffi cult to make a correct preoperative diagnosis of agenesis of the gallbladder in symptomatic patients. Th e 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 confi rmed. Th is 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 confi rm 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 diffi culties 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. Th ese 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 diffi culty 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 calcifi ed hepatic lesions with the WES triad.