Clinical Cholecystitis in the Absence of the Gallbladder

The congenital absence of the gallbladder (CAG) is a rare condition with an incidence of 13-65 cases/ 100,000 in the general population. This occurs when the gallbladder and the cystic duct fail to bud from the common bile duct during the fifth week of gestation. Most commonly, the patients with congenital absence of the gallbladder are asymptomatic. When symptomatic, they present as biliary colic, dyspepsia, jaundice or very rarely as acute cholecystitis. We present a case of a 27-year-old female who presented with acute right upper quadrant abdominal pain. Further evaluation with an ultrasound revealed a contracted gallbladder with stones. The hepatobiliary iminodiacetic acid scan was significant for non-visualization of the gallbladder, consistent with cystic duct obstruction. The laparoscopic cholecystectomy was attempted, however, the gallbladder was not visualized, and the procedure was aborted. The post-operative magnetic resonant cholangiopancreatography was consistent with the diagnosis of congenital absence of gallbladder.