Gall bladder agenesis: a surgeon’s dilemma


  • Jebin Joseph Department of General Surgery, INHS Dhanvantri, Port Blair, Andaman and Nicobar
  • Arun Kumar Department of General Surgery, 178 Military Hospital, Gangtok, Sikkim



Gall bladder, Agenesis, MRCP, Cholecystectomy


Congenital agenesis of gall bladder is a rare anomaly which poses a diagnostic dilemma to the surgical fraternity. Ultrasonography, which is the standard investigation of choice in gall bladder diseases often gives a mistaken diagnosis of cholelithiasis in the background of a shrunken gall bladder with hyperechoic shadows suggestive of gall stones. Intra-operatively this poses a surprise to the operating surgeon who fails to locate gall bladder in its normal anatomic position as well as any of the ectopic sites. The controversy in further course of management whether to abandon the procedure and follow-up with a post-operative imaging such as MRCP or to convert the laparoscopic procedure into an open surgery has been a debate for the surgeons. Most of the literature favours the first approach, thereby reducing the morbidity associated with the surgery. In this case report we present a 42-year-old male who presented with symptoms of gall bladder disease to a peripheral surgical centre and how we approached the intra-operative dilemma once gall bladder was not visualized.

Author Biographies

Jebin Joseph, Department of General Surgery, INHS Dhanvantri, Port Blair, Andaman and Nicobar

Department of General Surgery

Graded Specialist

Arun Kumar, Department of General Surgery, 178 Military Hospital, Gangtok, Sikkim

Department of Surgery

Graded Specialist


Kasi PM, Ramirez R, Rogal SS, Littleton K, Fasanella KE. Gallbladder Agenesis. Case Rep Gastroenterol. 2011;5(3):654-62.

Singh B, Satyapal KS, Moodley J, Haffejee AA. Congenital absence of the gall bladder. Surg Radiol Anat SRA. 1999;21(3):221-4.

Cho CH, Suh KW, Min JS, Kim CK. Congenital absence of gallbladder. Yonsei Med J. 1992;33(4):364-7.

Bennion RS, Thompson JE, Tompkins RK. Agenesis of the gallbladder without extrahepatic biliary atresia. Arch Surg Chic Ill 1960. 1988;123(10):1257-60.

Vijay KT, Kocher HH, Koti RS, Bapat RD. Agenesis of gall bladder--a diagnostic dilemma. J Postgrad Med. 1996;42(3):80-2.

Balakrishnan S, Singhal T, Grandy-Smith S, El-Hasani S. Agenesis of the Gallbladder: Lessons to Learn. JSLS. 2006;10(4):517-9.

Pipia I, Kenchadze G, Demetrashvili Z, Nemsadze G, Jamburia L, Zamtaradze T, et al. Gallbladder agenesis: A case report and review of the literature. Int J Surg Case Rep. 2018;53:235-7.

Tagliaferri E, Bergmann H, Hammans S, Azizi A, Stüber E, Seidlmayer C. Agenesis of the Gallbladder: Role of Clinical Suspicion and Magnetic Resonance to Avoid Unnecessary Surgery. Case Rep Gastroenterol. 2016;10(3):819-25.

Fiaschetti V, Calabrese G, Viarani S, Bazzocchi G, Simonetti G. Gallbladder agenesis and cystic duct absence in an adult patient diagnosed by magnetic resonance cholangiography: report of a case and review of the literature. Case Rep Med. 2009;2009:674768.

Turkel SB, Swanson V, Chandrasoma P: Manifestations associated with congenital absence of the gallbladder. J Med Genet. 1983;20:445-9.

Winter RB, Baraitser M. Multiple congenital anomalies. A diagnostic compendium. First Ed Cambridge: Chapman and Hall Medical. 1991: 109.

Velimezis G, Perrakis E, Perrakis A. Agenesis Of The Gallbladder: What To Do In Such A Rare Case? Presentation Of A Case And Review Of The Literature. Int J Surg. 2010;26:2.

Mittal A, Singla S, Singal R, Mehta V. Gallbladder agenesis with common bile duct stone--a rare case with a brief review of the literature. Turk J Gastroenterol Off J Turk Soc Gastroenterol. 2011;22(2):216-8.

Richards RJ, Taubin H, Wasson D. Agenesis of the gallbladder in symptomatic adults. A case and review of the literature. J Clin Gastroenterol. 1993;16(3):231-3.

Chowbey PK, Dey A, Khullar R, Sharma A, Soni V, Baijal M, et al. Agenesis of gallbladder - our experience and a review of literature. Indian J Surg. 2009;71(4):188-92.

Tang LM, Wang XF, Ren PT, Xu GG, Wang CS. The diagnosis of gallbladder agenesis: two cases report. Int J Clin Exp Med. 2015;8(2):3010-6.

Al-Hakkak SMM. Agenesis of gall bladder in laparoscopic cholecystectomy-A case report. Int J Surg Case Rep. 2017;39:39-42.

Malde S. Gallbladder agenesis diagnosed intra-operatively: a case report. J Med Case Reports. 2010;4(1):285.

Fulcher AS, Turner MA, Capps GW. MR cholangiography: technical advances and clinical applications. Radiogr Rev Publ Radiol Soc N Am Inc. 1999;19(1):25-41.

McCallum I, Jones MJ, Robinson SJ. Gallbladder agenesis. Ann R Coll Surg Engl. 2014;96(6):e28-29.

Rajkumar A, Piya A. Gall Bladder Agenesis: A Rare Embryonic Cause of Recurrent Biliary Colic. Am J Case Rep. 2017;18:334-8.

Scobie JL, Bramhall SR. Congenital agenesis of the gallbladder: a UK case report. Oxf Med Case Reports. 2016;2016(8).






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