1189 Agenesis of Gallbladder - a Rare Condition with Common Symptoms

Introduction Agenesis of the gallbladder is a rare abnormality with an incidence of 0.01-0.06%. Although patients are asymptomatic, half of them can present with abdominal pain, particularly biliary colic. Women are affected more than men with a likelihood ratio of 3:1. Case This is a case of a 50-year-old lady who presented with recurrent symptoms and signs of biliary colic type pain. All her routine bloods including inflammatory markers, Liver Function Test and amylase were within normal limits. A combination of Transabdominal ultrasound (USG), CT scan, MRCP, HIDA scans concluded gallbladder agenesis without extrahepatic biliary atresia. Currently, she is being managed conservatively with analgesia and antispasmodics. She is undergoing investigations like gastroscopy to rule out other causes of her symptoms. She has been referred to tertiary centre for Endoscopic USG and Sphincter of Oddi (SOD) Manometry. Discussion It is interesting to see how such a rare condition presents with a typical biliary symptom. However, diagnosis begins by ruling out any structural causes for the pain with radiological investigations as mentioned above including endoscopic USG, ERCP and analysis of bile for crystals. Finally, SOD manometry performed to rule out any SOD dysfunction which also can present with similar symptoms. A combination of antispasmodic and simple analgesia is effective for management of symptoms. Conclusions Biliary colic symptoms are common with gallbladder agenesis. MRCP is effective investigation for diagnosis. Antispasmodic medication and simple analgesia are the treatment of choice.