Gallbladder agenesis and pancreas divisum
Epigastric pain. No past history of surgery.
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The gallbladder and cystic duct are not visualized on any sequence including on 3D-MRCP. The common bile duct is dilated (10 mm in diameter) with no distal obstruction, may be assuming the function of bile storage.
Coronal MRCP reveals a dorsal pancreatic duct crossing anterior to the common bile duct, draining into the expected location of the minor papilla, indicating pancreas divisum.
Gallbladder agenesis is an extremely rare congenital malformation, with an incidence between 0.013 to 0.075% 2. The cystic duct can be absent, patent or shows hypoplastic cystic appearance 3. Several reported studies revealed a strong familial association. It can be seen in both adults and children.
MRCP (magnetic resonance cholangiopancreatography) is the gold standard imaging modality to exclude the possibility of an ectopic gallbladder and confirm the diagnosis. Preoperative MRCP should be performed in cases in which gallbladder is not visualized on ultrasound examination, before any surgical decision.
Additional contributor: R. Bouguelaa MD
- 1. AJ Cockbain, J Watson, GJ Toogood. Hepatobiliary and Pancreatic: Agenesis of the gallbladder. (2011) Journal of Gastroenterology and Hepatology. 26 (5): 935. doi:10.1111/j.1440-1746.2011.06740.x - Pubmed
- 2. Scobie, Jenna L., Bramhall, Simon R.. Congenital agenesis of the gallbladder: a UK case report. (2016) Oxford Medical Case Reports. 2016 (8): omw040. doi:10.1093/omcr/omw040 - Pubmed
- 3-Kwon AH, Yanagimoto H, Matsui Y, Imamura A. Agenesis of the gallbladder with hypoplastic cystic duct diagnosed at laparoscopy. (2006) Surgical laparoscopy, endoscopy & percutaneous techniques. 16 (4): 251-4. Pubmed