Agenesis of the gallbladder and choledocholithiasis: Case report.

Abstract

The most frequent elective procedure in general surgery in adults is cholecystectomy. During the procedure, many abnormalities may be found in the gallbladder and the common bile duct, being agenesis of the gallbladder the most uncommon, which can be difficult to manage even for an experimented surgeon. This type of malformation has the lowest incidence in the bile ducts, with only about 400 cases reported in the literature (1). The following article presents the case of a 44-year-old patient with a clinical picture of abdominal pain in the upper right quadrant, a clinical history of jaundice and acholia, with elevation of the liver profile (direct hyperbilirubinemia) and high probability of choledocholithiasis. The imaging studies (ultrasonography and magnetic resonance imaging of the bile ducts) did not detect any finding in the gallbladder. In consequence, endoscopic retrograde cholangiopancreatography (ERCP) was performed, but stone extraction was not achieved, therefore, a stent was required. The treatment led to biliary tract exploration by laparoscopy, confirming agenesis of the gallbladder, which was suspected based on previous magnetic resonance and ultrasound. A mechanical lithotripsy was performed with complete resolution of the clinical picture and improvement of the patient's initial symptomatology.

Keywords

• Gallbladder, abnormalities
• Choledocholithiasis
• Common bile duct diseases
• Laparoscopy
• CPRE