Intraoperative Diagnosis of Gallbladder Agenesis

2021 ◽  
pp. 000313482110604
Author(s):  
Maryselle Winters ◽  
Derek T. Clar ◽  
Kelly Van Fossen
Keyword(s):  
Ultrasound Examination ◽  
Rare Condition ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Biliary Colic ◽  
Imaging Findings ◽  
Intraoperative Diagnosis ◽  
Increased Risk ◽  
History Of ◽  
Elective Laparoscopic Cholecystectomy ◽  
Gallbladder Agenesis

Gallbladder agenesis is a congenital anomaly that often presents with symptoms of biliary colic. Due to the rarity of this condition, it is often difficult to diagnose pre-operatively. Here we present a case of a 33-yo female with a 6-month history of right upper quadrant abdominal pain and associated nausea. With false-positive imaging findings of cholelithiasis on ultrasound examination, an incidental intraoperative diagnosis of gallbladder agenesis was made during a routine elective laparoscopic cholecystectomy. This finding was confirmed with postoperative magnetic resonance cholangiopancreatography. The primary aim in reporting this case is to further promote awareness of this rare condition out of concern for increased risk of iatrogenic operative injury in the setting of a condition where conservative management is recommended.

scholarly journals Epehólyag-agenesia. Epekövességet utánzó ritka rendellenesség egy felnőtt nőben

2019 ◽  
Vol 160 (38) ◽  
pp. 1510-1513
Author(s):  
Călin Molnar ◽  
Tibor Sárközi ◽  
Cedric Kwizera ◽  
Marian Botoncea ◽  
Opriș Zeno ◽  
...  
Keyword(s):  
Rare Case ◽  
Medical Literature ◽  
Rare Condition ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Final Diagnosis ◽  
Biliary Colic ◽  
Caucasian Woman ◽  
Imaging Studies ◽  
History Of ◽  
Gallbladder Agenesis

Abstract: Gallbladder agenesis is a rare congenital malformation due to an embryological defect of the biliary system. In most cases it is asymptomatic, but it can also mimic biliary colic. We report the case of a 72-year-old Caucasian woman with a medical history of cardiovascular disease and hypercholesterolemia, under cholesterol-lowering and hypotensive treatment, who presented symptoms suggesting biliary colic. She underwent laparoscopic surgery that confirmed the final diagnosis. We present our approach in this rare case as well as a brief review of medical literature. The surgeon should decide intraoperatively whether to continue and search for a possible ectopic gallbladder or investigate further with imaging studies. Gallbladder agenesis is a rare condition that the surgeon must be aware of. In the cases of inconclusive or indirect signs of cholelithiasis, the best approach is complementary imaging investigations such as magnetic resonance cholangiopancreatography in order to avoid surgery. Orv Hetil. 2019; 160(38): 1510–1513.

EP.TH.665Where’s the gallbladder? A rare case of gallbladder agenesis with cystic duct stone

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Tiffany Cheung ◽  
Roberto Presa ◽  
Antonio Manzelli
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Cystic Duct ◽  
De Novo ◽  
Stone Formation ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Filling Defect ◽  
Biliary Colic ◽  
Biliary Duct ◽  
Increased Risk ◽  
Gallbladder Agenesis

Abstract Aims Gallbladder agenesis is a rare congenital anatomical malformation with an incidence of 0.007-0.0027%. Although usually asymptomatic, clinically it may present similarly to biliary colic. There may be increased risk of de novo biliary duct stone formation due to biliary dyskinesia, subsequent duct dilatation and biliary stasis. We present a case of incidental gallbladder agenesis identified during intended laparoscopic cholecystectomy. Methods A 68 year-old female with no significant comorbidities presented with a 16 hour history of colicky right upper quadrant pain and vomiting. She had been awaiting cholecystectomy for increasingly symptomatic gallstones, most recently visualised within a contracted gallbladder on ultrasound two months prior. Recurrently obstructive LFT’s warranted urgent magnetic resonance cholangiopancreatography (MRCP), which identified a poorly-visualised contracted gallbladder and a 10mm common bile duct without filling defect. At index laparoscopic cholecystectomy, a very small thick-walled structure resembling the gallbladder was identified and safely excised in retrograde; a stone was seen within. Results Macroscopic examination revealed a 27 x 9 x 11mm piece of dark brown tissue containing soft orange material. Microscopic histological examination confirmed this to be cystic duct focally lined by mucinous epithelium with chronic inflammation. Findings were consistent with gallbladder agenesis. Conclusions Although rare, it is important for surgeons to maintain an index of suspicion for gallbladder agenesis, particularly if repeated imaging demonstrates a poorly-visualised or ‘contracted’ gallbladder despite adequate fasting. Furthermore, as in this case, the presence of ‘gallbladder’ stones radiologically does not preclude gallbladder agenesis. Anticipation of this malformation may aid interpretation of biliary anatomy, if incidentally found intra-operatively.

scholarly journals Acute Cholecystitis-like Presentation in an Adult Patient with Gallbladder Agenesis: Case Report and Literature Review

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Nahla Elzubeir ◽  
Kevin Nguyen ◽  
Muhammad Nazim
Keyword(s):  
Case Report ◽  
Acute Cholecystitis ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Biliary Colic ◽  
Ulcer Disease ◽  
Presenting Symptoms ◽  
Hida Scan ◽  
Additional Imaging ◽  
History Of ◽  
Gallbladder Agenesis

Introduction. Gallbladder agenesis (GA) is a rare congenital malformation, and majority are asymptomatic; however, symptomatic patients present with a clinical picture similar to biliary colic. Work up usually shows contracted gallbladder (GB) on ultrasound (US), and HIDA scan shows nonvisualization. Magnetic resonance cholangiopancreatography (MRCP) can be helpful in the diagnosis; however, the diagnosis without the latter can only be established intraoperatively. Management should be conservative treatment with antispasmodic drugs. Case Report. A 35-year-old female presented to the emergency department with nausea, vomiting, and worsening right upper quadrant (RUQ) abdominal pain. Vitals and laboratory values were unremarkable except for mild leukocytosis, and RUQ US reported “contracted GB, cholelithiasis, 4.2 mm wall thickness, and no ductal dilation.” Surgical consultation was prompted by the diagnosis of acute cholecystitis. The patient was transferred to the operating room for laparoscopic cholecystectomy; however, no GB was found, which was confirmed by intraoperative indocyanine green cholangiography. The procedure was aborted. Postoperatively, CT scan showed absent GB. A HIDA scan showed nonvisualization of the GB after 4 hours. Gastroenterology consultation was suggested to assess for peptic ulcer disease, stricture, or other etiology for her presenting symptoms, and the upper endoscopy showed gastritis. Upper GI with small bowel follow-through study showed mild delayed gastric emptying and contrast in the colon in 45 minutes. Conclusion. When US imaging findings are equivocal for nonvisualization of GB in a patient with no known history of prior cholecystectomy, additional imaging is required considering the diagnosis of gallbladder agenesis. MRCP is the test of choice. Management is usually conservative with smooth muscle relaxants without the need for surgical operation.

scholarly journals A Rare Anomaly of Biliary System: MRCP Evidence of a Cystic Duct Cyst

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Cemil Goya ◽  
Mehmet Serif Arslan ◽  
Alpaslan Yavuz ◽  
Cihad Hamidi ◽  
Suzan Kuday ◽  
...  
Keyword(s):  
Cystic Duct ◽  
Clinical Symptoms ◽  
Rare Condition ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Biliary Colic ◽  
Cystic Dilatation ◽  
Duct Cyst ◽  
Abdominal Ultrasonography ◽  
Number Of Patients ◽  
The Right

Cystic duct cysts are a rare congenital anomaly. While the other bile duct cysts (choledochus and the intrahepatic bile ducts) are classified according to the classification described by Tadoni, there is no classification method described by the cystic duct cysts, although it is claimed that the cystic duct cysts may constitute a new “Type 6” category. Only a limited number of patients with cystic duct cysts have been reported in the literature. The diagnosis is usually made in the neonatal period or during childhood. The clinical symptoms are nonspecific and usually include pain in the right upper quadrant and jaundice. The condition may also present with biliary colic, cholangitis, cholelithiasis, or pancreatitis. In our case, the abdominal ultrasonography (US) performed on a 6-year-old female patient who presented with pain in the right upper quadrant pointed out an anechoic cyst at the neck of the gall bladder. Based on the magnetic resonance cholangiopancreatography (MRCP) results, a cystic dilatation was diagnosed in the cystic duct. The aim of this case-report presentation was to discuss the US and MRCP findings of the cystic dilatation of cystic duct, which is an extremely rare condition, in the light of the literature information.

scholarly journals Unilateral Twin Ectopic Pregnancy in a Patient With a History of Multiple Sexually Transmitted Infections

2006 ◽  
Vol 2006 ◽  
pp. 1-3 ◽  
Author(s):  
Charles J. Rolle ◽  
Clifford Y. Wai ◽  
Roger Bawdon ◽  
Rigoberto Santos-Ramos ◽  
Barbara Hoffman
Keyword(s):  
Ectopic Pregnancy ◽  
Sexually Transmitted Infections ◽  
Fallopian Tube ◽  
Lower Abdominal Pain ◽  
Rare Condition ◽  
Operative Trauma ◽  
Sexually Transmitted ◽  
Uncommon Presentation ◽  
Increased Risk ◽  
History Of

Background. The incidence of unilateral twin ectopic pregnancy is a rare condition. Several factors increase the risk of ectopic pregnancy, the most important of which is pelvic inflammatory disease, followed by operative trauma, congenital anomalies, tumors, and adhesions resulting in anatomically distorted fallopian tubes. We present a case of a woman with a history of four confirmed sexually transmitted infections (STIs) including Chlamydia trachomatis, Neisseria gonorrhoeae, herpes simplex virus 2, and Treponema pallidum. The case illustrates the potential impact of sexually transmitted infections (STIs) on the risk of a twin ectopic pregnancy. Case. A 24-year-old primigravida, presented with an unknown last menstrual period, lower abdominal pain, watery vaginal discharge, and vaginal spotting. During this hospitalization, serumβ-HCG testing was 263 mIU/mL and transvaginal ultrasonographic examination suggested a nonviable unilateral twin ectopic pregnancy. At exploratory laparotomy, a 10 cm mass involving the right fallopian tube and ovary was excised. Pathological evaluation of the specimen identified a monochorionic, diamnionic twin ectopic pregnancy within the fallopian tube. Conclusions Patients with a history of multiple (STIs) are known to be at risk for the development of chronic pelvic infection and postinflammatory scarring. The resulting distortion of the normal tubal anatomy leads to an increased risk of an uncommon presentation of ectopic pregnancy.

scholarly journals P-BN16 Gallbladder agenesis in a gentleman presenting with biliary sepsis: a case report and review of literature

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Rory Hammond ◽  
Thahesh Tharmaraja ◽  
Daniel Bell ◽  
Venugopala Kalidindi
Keyword(s):  
Incidental Finding ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Liver Function Tests ◽  
Final Diagnosis ◽  
Diagnostic Challenge ◽  
Non Invasive ◽  
Biliary Sepsis ◽  
Operative Exploration ◽  
History Of ◽  
Gallbladder Agenesis

Abstract Background Gallbladder agenesis (GBA) is a well-recognised, yet rare embryological malformation, that is thought to stem from a failure of the gallbladder and cystic duct to bud from the common bile duct in the 5th week of gestation. The anomaly has an estimated incidence of 10-65 per 100 000 and is often an incidental finding. A quarter of those affected are symptomatic, often presenting in a similar manner to cholecystitis or choledocholithiasis. There is a lack of awareness and guidance on its investigation and management, making GBA a diagnostic challenge, which often leads to unnecessary high-risk surgical exploration. Methods A 64-year-old man presented with right upper quadrant abdominal pain, fevers, jaundice and persistent vomiting. On examination he was confused, visibly jaundiced and septic with deranged liver function tests. An initial ultrasound scan of the abdomen revealed dilated common bile ducts, with no evidence of choledocholithiasis, however, a gallbladder could not be identified. Magnetic resonance cholangiopancreatography confirmed a ‘post-cholecystectomy’ picture, despite no history of abdominal surgery. This led us to the diagnosis of gallbladder agenesis. Results There are no dedicated guidelines regarding the investigation and management of GBA. Efforts have been made to stratify the diagnostic imaging of GBA. Malde et al suggest that if the gallbladder is not visualised on USS, the next most appropriate investigations in order of accuracy are MRCP, CT and ERCP, respectively. Interestingly, they further suggest that if results of imaging remain inconclusive, they should be repeated again once the acute phase of the illness or symptoms have resolved. Inadvertently, this suggestion was applied in our case, as the patient underwent a repeat MRCP following the resolution of his acute symptoms. In our case, MRCP allowed an effective final diagnosis, avoiding unnecessary investigations and exploratory surgery. It also provided a detailed anatomical picture, excluding the possibility of an ectopic gallbladder.  Conclusions The present case accentuates the importance of non-invasive imaging such as MRCP in appropriately diagnosing this phenomenon and avoiding unnecessary operative exploration. 

scholarly journals Agenesis of the Gallbladder: Role of Clinical Suspicion and Magnetic Resonance to Avoid Unnecessary Surgery

2017 ◽  
Vol 10 (3) ◽  
pp. 819-825 ◽  
Author(s):  
Eugenio Tagliaferri ◽  
Heinrich Bergmann ◽  
Sebastian Hammans ◽  
Alireza Azizi ◽  
Eckhard Stüber ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Anatomical Variation ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Clinical Suspicion ◽  
Biliary Colic ◽  
Correct Treatment ◽  
Radiological Features ◽  
Gallbladder Agenesis ◽  
Unnecessary Intervention

Isolated agenesis of the gallbladder is usually a rare asymptomatic anatomical variation, with an estimated incidence of 10–65 per 100,000. Females are more commonly affected (ratio 3: 1), with the disease typically presenting in the second or third decade of their life. Despite an absent gallbladder, half of the patients present with symptoms similar to biliary colic, which is poorly understood. The rarity of this condition combined with its clinical and radiological features often lead to a wrong preoperative diagnosis so that many patients undergo unnecessary operative intervention. Herein, we present the case of a 56-year-old female with a typical biliary colic who was diagnosed to have gallbladder agenesis. Computed tomography and magnetic resonance cholangiopancreatography allowed correct treatment and prevented an unnecessary intervention.

scholarly journals Elective laparoscopic cholecystectomy: recurrent biliary admissions predispose to difficult cholecystectomy

2022 ◽  
Author(s):  
James Lucocq ◽  
John Scollay ◽  
Pradeep Patil
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Adverse Outcomes ◽  
Clinical Indication ◽  
Biliary Colic ◽  
Surgical Decision ◽  
Operative Outcomes ◽  
Increased Risk ◽  
Difficult Cholecystectomy ◽  
Elective Laparoscopic Cholecystectomy ◽  
Surgical Decision Making

Abstract Introduction Patients undergoing elective laparoscopic cholecystectomy (ELLC) represent a heterogeneous group making it challenging to stratify risk. The aim of this paper is to identify pre-operative factors associated with adverse peri- and post-operative outcomes in patients undergoing ELLC. This knowledge will help stratify risk, guide surgical decision making and better inform the consent process. Methods All patients who underwent ELLC between January 2015 and December 2019 were included in the study. Pre-operative data and both peri- and post-operative outcomes were collected retrospectively from multiple databases using a deterministic records-linkage methodology. Patients were divided into groups based on clinical indication (i.e. biliary colic versus cholecystitis) and adverse outcomes were compared. Multivariate regression models were generated for each adverse outcome using pre-operative independent variables. Results Two-thousand one hundred and sixty-six ELLC were identified. Rates of peri- and post-operative adverse outcomes were significantly higher in the cholecystitis versus biliary colic group and increased with number of admissions of cholecystitis (p < 0.05). Rates of subtotal (29.5%), intra-operative complication (9.8%), post-operative complications (19.6%), prolonged post-operative stay (45.9%) and re-admission (16.4%) were significant in the group of patients with ≥ 2 admissions with cholecystitis. Conclusion Our data demonstrate that patients with repeated biliary admission (particularly cholecystitis) ultimately face an increased risk of a difficult ELLC with associated complications, prolonged post-operative stay and readmissions. These data provide robust evidence that individualised risk assessment and consent are necessary before ELLC. Strategies to minimise recurrent biliary admissions prior to LC should be implemented.

scholarly journals Successful Use of the 308-nm Excimer Laser in Early Patch Stage Mycosis Fungoides

2019 ◽  
Vol 10 (3) ◽  
pp. 251-253
Author(s):  
Andrew M. Armenta ◽  
Krystal M. Jones ◽  
Jason S. Reichenberg
Keyword(s):  
Case Report ◽  
Skin Cancer ◽  
Mycosis Fungoides ◽  
Excimer Laser ◽  
Early Stage ◽  
Treatment Options ◽  
Rare Condition ◽  
Dysplastic Nevi ◽  
Increased Risk ◽  
History Of

Introduction: Mycosis fungoides (MF), a type of cutaneous T-cell lymphoma, is a rare condition with a variety of treatment options. A frequently utilized method in the treatment of early-stage MF is phototherapy. Full body phototherapy can be associated with photoaging of the skin and an increased risk of developing skin cancer. Targeted phototherapy, with a 308-nm excimer laser, may be just as effective and of a lower risk. This makes it especially useful in the treatment of patients with dysplastic nevi (DN) or other conditions which can put them at a higher risk of developing skin cancer. There are currently limited data on the treatment of early-stage MF with an excimer laser. Case Report: This study reports on a 43-year-old female patient presented to the clinic with early-stage (Ia) MF. Given her history of DN, she wished to pursue targeted phototherapy with an excimer laser. Localized light treatment was performed via a 308-nm excimer laser, 3 times weekly, for a total of 17 treatments to affected lesions. Following excimer laser treatment, she had a clinical resolution of her patches. On the follow-up clinic visits, she maintained her excellent response 12 months out. Conclusion: Targeted phototherapy with a 308-nm excimer laser may be a safer and equally effective alternative to generalized phototherapy in the treatment of early-stage MF. This case report demonstrates its efficacy and advantages over traditional generalized phototherapy.

scholarly journals Role of Computed Tomography in Pediatric Traumatic Brain Injury and its Correlation with Glasgow Coma Scale at Presentation

2016 ◽  
Vol 22 (3) ◽  
Author(s):  
Ahmad Imran ◽  
Abid Ali Qureshi ◽  
Amna Tariq
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Radiation Exposure ◽  
Age Group ◽  
Pediatric Age ◽  
Imaging Findings ◽  
Pediatric Age Group ◽  
Increased Risk ◽  
History Of

<p>The study was aimed at documenting the relationship between Glasgow coma score with imaging findings on computed tomography in children with traumatic brain injury. Un-necessary radiation exposure can be detrimental in pediatric age group and can lead to an increased risk of radiation induced malignancies.</p><p><strong>Patients and Methods:</strong><strong>  </strong>This retrospective study was conducted in Department of Radiology Lahore from 15.8.11 to 15.11.11. It included 48 children who presented in emergency department with history of fall or trauma to head. These patients underwent computed tomography using standard imaging protocols. All the data was analyzed by using SPSS version 17.</p><p><strong>Results:</strong><strong>  </strong>A total of 48 patients from 6 months to 15 years of age with history of fall or trauma to head who underwent CT scan were included in study. 20 (42%) patients revealed normal study. Extra/intra axial bleed is noted in 11 (23%), evidence of cerebral edema was</p><p>noted in 4 (8%) patients. 9 (19%) patients had fracture of skull bones and cephalhematoma was noted among 4 (8%) patients. Imaging findings were seen in majority of the patients with GCS less than 13/15.</p><p><strong>Conclusion:</strong><strong>  </strong>Neuroimaging can serve as a useful guide regarding management of traumatic brain injury however un-necessary radiation exposure is detrimental in pediatric age group. A correlation between GCS and decision regarding imaging can serve as an effective approach to decrease rates of neuro imaging after pediatric head trauma.</p>

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