A Case of Symptomatic Gallbladder Agenesis with Chronic Abdominal Symptoms

The anatomical area of the extrahepatic bile ducts exhibits plethora of anatomic variants. The detailed study and comprehension of anatomic variations of extrahepatic bile ducts is a prerequisite in order to avoid the intraoperative biliary or tract damages, but they are also necessary for the targeted treatment of any complications. Gallbladder agenesis is a rare congenital anomaly of the biliary tree with an estimated incidence of 0.007-0.027% in surgical series which is much lower compared to the incidence of other gallbladder anomalies. It may be asymptomatic, but sometimes is associated with symptoms such as upper quadrant abdominal pain, which may be mistaken for cholecystitis and can lead the patient to the operating room. We present a case of a 30-year-old male patient without any significant past medical history presented with a 2-year history of upper abdominal complaints, dyspepsia, epigastric abdominal pain and weight loss, normal laboratory workup and unclear radiological signs which led him to exploratory laparoscopy due to the patient’s chronic symptoms, in order to exclude the presence of another underlying pathologic process. In addition to our case presentation, a relative  review of literature was conducted. As a conclusion, examinations, such as transabdominal ultrasonography, may be misleading and MCRP should be the principal method of investigation to establish a presumptive diagnosis. However, in cases with a strong suspicion for a different underlying pathology, further investigation with exploratory laparoscopy may be warranted.

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Proximal Extrahepatic Bile Ducts: Comprehensive Review

Journal of oncology: diagnostic radiology and radiotherapy ◽

10.37174/2587-7593-2021-4-1-74-93 ◽

2021 ◽

Vol 4 (1) ◽

pp. 74-93

Author(s):

M. A. Shorikov ◽

O. N. Sergeeva ◽

M. G. Lapteva ◽

N. A. Peregudov ◽

B. I. Dolgushin

Keyword(s):

Bile Duct ◽

Bile Flow ◽

Bile Ducts ◽

Extrahepatic Bile Duct ◽

Hepatic Duct ◽

Biliary Tree ◽

Comprehensive Review ◽

Extrahepatic Bile Ducts ◽

And Function ◽

Variant Anatomy

Proximal extrahepatic bile ducts are the biliary tree segment within formal boundaries from cystic ductcommon hepatic duct junction to sectoral hepatic ducts. Despite being a focus of attention of diagnostic and interventional radiologists, endoscopists, hepatobiliary surgeons and transplantologists they weren’t comprehensively described in available papers. The majority of the authors regard bile duct confluence as a group of merging primitively arranged tubes providing bile flow. The information on the proximal extrahepatic bile duct embryonal development, variant anatomy, innervation, arterial, venous and lymphatic supply is too general and not detailed. The present review brought together and systemized exiting to the date data on anatomy and function of this biliary tract portion. Unique, different from the majority of hollow organs organization of the proximal extrahepatic bile duct adapts them to the flow of the bile, i.e. viscous aggressive due to pH about 8.0 and detergents fluid, under higher wall pressure than in other parts of biliary tree.

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A RARE CASE OF PRIMARY PANCREATIC HYDATID CYST CAUSING BILIARY TREE DILATATION

10.36106/ijsr/4006049 ◽

2021 ◽

pp. 13-14

Author(s):

R. Deepthi ◽

Sai kumar Reddy. kami reddy ◽

Nasin Usman

Keyword(s):

Abdominal Pain ◽

Hydatid Cyst ◽

Echinococcus Granulosus ◽

Hydatid Disease ◽

Rare Case ◽

Biliary Tree ◽

Cystic Lesions ◽

Endemic Areas ◽

Upper Abdominal ◽

Ct And Mri

Echinococcus granulosus complex is the causative parasite of hydatid disease, endemic to regions with stock breeding and agriculture. We present a rare case of primary pancreatic hydatid disease in a 20-year-old female who had complaints of upper abdominal pain and epigastric fullness. The typical radiological ndings in ultrasound, CT and MRI helps to differentiate this lesion from other cystic lesions in the pancreas. Therefore this lesion should be kept as a differential in endemic areas

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Omental Infarction Mimicking Cholecystitis

Case Reports in Surgery ◽

10.1155/2015/687584 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3

Author(s):

David Smolilo ◽

Benjamin C. Lewis ◽

Marina Yeow ◽

David I. Watson

Keyword(s):

Abdominal Pain ◽

Neck Pain ◽

Abdominal Wall ◽

Vascular Supply ◽

Shortness Of Breath ◽

Atypical Form ◽

Omental Infarction ◽

Shoulder And Neck Pain ◽

Upper Abdominal ◽

Exploratory Laparoscopy

Omental infarction can be difficult to diagnose preoperatively as imaging may be inconclusive and patients often present in a way that suggests a more common surgical pathology such as appendicitis. Here, a 40-year-old Caucasian man presented to casualty with shortness of breath and progressive right upper abdominal pain, accompanied with right shoulder and neck pain. Exploratory laparoscopy was eventually utilised to diagnose an atypical form of omental infarction that mimics cholecystitis. The vascular supply along the long axis of the segment was occluded initiating necrosis. In this case, the necrotic segment was adherent with the abdominal wall, a pathology not commonly reported in cases of omental infarction.

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A rare case of gastric fundus tuberculosis with nonspecific abdominal pain

Journal of International Medical Research ◽

10.1177/03000605211033189 ◽

2021 ◽

Vol 49 (7) ◽

pp. 030006052110331

Author(s):

Feiyu Yan ◽

Xianzhe Yu ◽

Hongjun Lei ◽

Yi Chen ◽

Jiwei Wang ◽

...

Keyword(s):

Abdominal Pain ◽

Rare Case ◽

Histopathological Examination ◽

Submucosal Tumor ◽

Treatment Delay ◽

Gastric Fundus ◽

Abdominal Symptoms ◽

High Incidence ◽

Upper Abdominal ◽

Space Occupying Lesion

A 53-year-old patient who experienced recurring upper abdominal pain and discomfort for 4 years was admitted to our hospital. Gastroscopy was performed to identify the location of the pain and evaluate the characteristics of a mass in the abdomen. Endoscopic ultrasonography (EUS) and abdominal computed tomography (CT) revealed a space-occupying lesion in the gastric fundus, suggestive of a submucosal tumor and highly likely of stromal origin. Surgical resection of the lesion was performed for identification; however, postoperative histopathological examination of the lesion revealed gastric fundus tuberculosis (TB). Gastric TB is relatively rare; therefore, clinicians should be highly suspicious of patients with abdominal symptoms from regions with a high incidence of TB to prevent treatment delay caused by misdiagnosis.

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Symptom complaints, psychiatric disorder and abnormal illness behaviour in patients with upper abdominal pain

Psychological Medicine ◽

10.1017/s003329170000982x ◽

1988 ◽

Vol 18 (4) ◽

pp. 887-892 ◽

Cited By ~ 37

Author(s):

Stephen Colgan ◽

Francis Creed ◽

Howard Klass

Keyword(s):

Abdominal Pain ◽

Psychiatric Disorder ◽

Psychiatric Illness ◽

Functional Abdominal Pain ◽

Illness Behaviour ◽

Symptom Pattern ◽

Abdominal Symptoms ◽

Upper Abdominal ◽

Fatigue Detection ◽

Symptom Complaints

SynopsisSeventy patients presenting to the gastroenterologist with upper abdominal pain were examined by a psychiatrist to establish the presence of psychiatric disorder, illness behaviour and to record in detail their symptom pattern. The 37 patients who had no organic cause for their abdominal complaints were subdivided into those with and without psychiatric disorder. The former (21 patients) demonstrated more illness behaviour, they complained of more abdominal symptoms and their pain was both more severe and more persistent than in the patients with organic disease and those with non-organic illness who did not have psychiatric disorder. The latter group reported no symptoms of ‘psychoneurosis’ and should probably be regarded as a separate group if the aetiology of functional abdominal pain is to be clarified. Those with non-organic abdominal complaints who had psychiatric illness could be distinguished by the presence of three symptoms, namely depression, anxiety and fatigue. Detection and treatment of their psychiatric disorder might lead to a decrease in their symptomatic complaints and illness behaviour.

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Tutorial Review for Understanding of Cholangiopathy

International Journal of Hepatology ◽

10.1155/2012/547840 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 6

Author(s):

Yasuni Nakanuma

Keyword(s):

Epithelial Cells ◽

Bile Ducts ◽

Biliary Tree ◽

Special Issue ◽

Anatomy And Physiology ◽

Biliary Epithelial Cells ◽

Extrahepatic Bile Ducts ◽

Bile Duct Damage ◽

Peribiliary Glands ◽

Extrahepatic Biliary Tree

The biliary tree consists of intrahepatic and extrahepatic bile ducts and is lined by biliary epithelial cells (or cholangiocytes). There are also peribiliary glands around the intrahepatic large bile ducts and extrahepatic bile ducts. The biliary tree is a conduit of bile secreted by hepatocytes and biliary epithelial cells and also of the peribiliary glands and has several physiological roles. A number of diseases affect mainly the intrahepatic and extrahepatic biliary tree, and, in this special issue, these cholangiopathies are reviewed in detail with respect to genetics, pathogenesis, and pathology. In this paper, the anatomy and physiology of the biliary tree, basic injuries to biliary epithelial cells from stress and bile duct damage, and representative cholangiopathies are briefly reviewed.

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P-EGS16 Lemmel Syndrome due to Duodenal Diverticulitis, an Infrequent Cause of Biliary Obstruction

British Journal of Surgery ◽

10.1093/bjs/znab430.076 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Joseph Natale ◽

Mohamed Abdelrahman ◽

Timothy Wheatley

Keyword(s):

Abdominal Pain ◽

Inflammatory Markers ◽

Biliary Obstruction ◽

Biliary Tree ◽

Diagnostic Tools ◽

Pancreatic Ducts ◽

Duct Occlusion ◽

Duodenal Diverticula ◽

Duodenal Diverticulitis ◽

Upper Abdominal

Abstract Background Lemmel syndrome, first described in 1934, is the presence of biliary obstruction as a consequence of duodenal diverticula. The precise aetiology remains uncertain. Multiple causative theories have been proposed. These include mechanical biliopancreatic duct occlusion, functional disruption of the sphincter of Oddi and alteration of the course of the distal biliary and pancreatic ducts. We present a case of biliary obstruction caused by diverticulitis of a solitary duodenal diverticulum. Methods A 71-year-old woman with no co-morbidities presented with early satiety, cachexia and upper abdominal pain. An epigastric mass was palpable, alkaline phosphatase was 247 iu/L, alanine transaminase 124iu/L, bilirubin 4umol/L and C-reactive protein 68mg/L. Computed tomography (CT) of the abdomen and pelvis revealed obstructed biliary tree with D2 duodenal diverticulitis. Magnetic resonance cholangiopancreatography (MRCP) displayed a causative enterolith. Treatment with antibiotics was initiated and the patient commenced on liquid diet. Liver function tests and inflammatory markers normalised. After a seven day admission patient was discharged and oral intake normalised. Interval MRCP revealed resolution of obstruction and inflammation. Results Duodenal diverticula occur in 1-20% of individuals. Complications are symptoms are uncommon. Diverticulitis is a rare complication. Malignancy and cholelithiasis should be excluded in diagnostic workup. The mainstay of therapy for duodenal diverticulitis is conservative. CT and MRCP are effective diagnostic tools. Diverticulectomy carries substantial risk of morbidity and mortality. Endoscopic sphincterotomy or lavage have a role in relief of biliary obstruction when present. Comparative prospective studies of management do not exist and retrospective enquiry is sparse. Management is thereby best determined clinically on a case by case basis. Surgery is reserved for failed conservative and medical therapy. Conclusions Duodenal diverticulitis should be considered in patients with unexplained upper abdominal pain and elevated inflammatory markers. In combination with obstructive jaundice, suspicions should be raised for acute inflammation causing obstruction to the biliary tree. Cross sectional imaging is useful in determining the diagnosis. Antibiotics and conservative therapy are prudent first line management in the absence of perforation. Where these measures are inadequate endoscopic and operative strategies may be employed but have no robust evidence basis.

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Enterogastric Reflux: an Uncommon Diagnosis Analyzed by Hepatobiliary Imaging

Journal of Case Reports in Medicine ◽

10.25149/jcrm.v8i2.178 ◽

2019 ◽

Vol 8 (2) ◽

Author(s):

Peter Wang

Keyword(s):

Abdominal Pain ◽

Digestive Enzymes ◽

Gallbladder Disease ◽

Hepatobiliary Scintigraphy ◽

Hepatobiliary Imaging ◽

Upper Gi ◽

Gi Symptoms ◽

Upper Abdominal ◽

Enterogastric Reflux

Enterogastric reflux (EGR) is the reflux of bile and digestive enzymes from the small bowel into the stomach. While it is a normal physiologic process in small amounts, excessive reflux and chronic EGR can cause upper GI symptoms often mimicking more common diseases such as gallbladder disease and GERD that often leads to its underdiagnosis. Identifying EGR is significant as it has been associated with the development of gastroesophogeal pathology including gastritis, esophagitis, ulcers, and mucosal metaplasia. This article presents a 22-year-old male with enterogastric reflux causing upper abdominal pain and will discuss the role of hepatobiliary scintigraphy in its diagnosis.

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