Gallbladder agenesis

A 34-year-old man without previous medical history was admitted for right hypochondrium pain with nausea and vomiting. Blood tests were normal and abdominal echography described a difficult to find gallbladder but suspected biliary lithiasis. The diagnosis of uncomplicated symptomatic cholelithiasis was proposed and laparoscopic cholecystectomy was indicated. At laparoscopy, the gallbladder could not be found (Fig 1) allowing the diagnosis of gallbladder agenesis. A later gastroscopy showed erythematous gastritis successfully managed with an oral proton pump inhibitor. Gallbladder agenesis was confirmed one month later with magnetic resonance cholangiopancreatography (Fig 2) that also showed a slightly enlarged common bile duct (13 mm).
Gallbladder agenesis is a rare congenital abnormality with an incidence evaluated between 10 to 90 per 100,000 live births [1,2]. It has been linked to some biliary pain due to Oddi's sphincter dysfunction [3]. In most reported cases, gallbladder agenesis is misdiagnosed for shrunken gallbladder at ultrasound, but confirmed during unnecessary laparoscopy [4,5].