Agenesis of the gallbladder

Case contributed by Dr. Dana M DeCarlo

Presentation

History of dextrocardia, tracheo-oesophageal fistula, presenting with acute onset of severe abdominal pain, nausea, and vomiting. There was concern for appendicitis versus bowel obstruction. CT scan was performed for further evaluation following non-visualization of the gallbladder on ultrasound.

Patient Data

Age: 10 years
Gender: Male
CT

CT Abdomen

The gallbladder is congenitally absent.  The common bile duct is non-dilated.  Visualized portions of the appendix (not shown here) were normal.  Trace free fluid in the right lower quadrant seen here was considered reactive in this patient with clinical diagnosis of gastroenteritis.

Case Discussion

This is a young male with dextrocardia and TE fistula who presented with acute onset of severe abdominal pain, nausea, and vomiting.  The clinical picture was concerning for appendicitis versus obstruction.  CT scan was performed for further evaluation following non-visualization of the gallbladder on ultrasound. 

The incidence of gallbladder agenesis is 10-75 per 100,000 population (Al-Hakkak, 2017).  There have been reports of associated cardiovascular anomalies (Turkel, 1983 and Muguruma, 2001).  Turkel et al published a retropective study of 34 patients with congential absence of the gallbladder.  Of these, 23% had associated TE fistula and 54% had cardiac defects.  The cardiac defects included tetralogy of Fallot, VSD or ASD, TAPVR, truncus arteriosus, and aortic arch anomalies (Turkel, 1983).  Association with dextrocardia as in our case has not been reported previously.

This case was submitted with supervision and input from:

Soni C. Chawla, M.D.
Associate Professor
Department of Radiological Sciences
David Geffen School of Medicine at UCLA
Olive View - UCLA Medical Center 

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Case information

rID: 55454
Case created: 6th Sep 2017
Last edited: 19th Sep 2017
Inclusion in quiz mode: Included
Institution: Olive View - UCLA Medical Center

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