Agenesia de la vesícula biliar: una serie de casos multicéntrica y revisión de la literatura / Agenesis of the gallbladder: A multicenter case series and review of the bibliography

La agenesia de la vesícula biliar es una entidad rara en pediatría con una evolución normalmente silente, y representa un desafío diagnóstico para el médico que enfrenta estos casos por primera vez. Algunos pacientes pueden, sin embargo, presentar síntomas que simulan otras patologías del árbol biliar, y muchos de ellos son operados ante esta sospecha. Sin embargo, el diagnóstico oportuno de esta entidad permite llevar a cabo un tratamiento médico que muchas veces es suficiente para resolver el problema del paciente. Si bien es una condición benigna, los pacientes suelen presentar otras malformaciones asociadas que son más graves en naturaleza y que deben investigarse activamente para poder derivarlos a los especialistas de manera oportuna. Presentamos nuestra experiencia en el diagnóstico y tratamiento de estos pacientes, así como una breve revisión de la literatura. Esperamos que sea de utilidad para el médico que encuentre un caso similar.

Gallbladder agenesis is a rare condition in pediatrics that is usually asymptomatic and represents a diagnostic challenge for physicians seeing these cases for the first time. Some patients may, however, present with symptoms that mimic other diseases of the bile ducts, and many of them undergo surgery due to such suspicion. Still, a timely diagnosis of gallbladder agenesis allows for medical treatment that is often sufficient to resolve the patient's problem. Although it is a benign condition, patients often present with other associated, more serious malformations and should be actively studied for a timely referral to other specialists. Here we describe our experience with the diagnosis and treatment of these patients and a brief review of the bibliography. We hope it will be helpful for physicians facing similar cases.

Agenesis of the gallbladder: A multicenter case series and review of the bibliography. / Agenesia de la vesícula biliar: una serie de casos multicéntrica y revisión de la literatura.

Gallbladder agenesis is a rare condition in pediatrics that is usually asymptomatic and represents a diagnostic challenge for physicians seeing these cases for the first time. Some patients may, however, present with symptoms that mimic other diseases of the bile ducts, and many of them undergo surgery due to such suspicion. Still, a timely diagnosis of gallbladder agenesis allows for medical treatment that is often sufficient to resolve the patient's problem. Although it is a benign condition, patients often present with other associated, more serious malformations and should be actively studied for a timely referral to other specialists. Here we describe our experience with the diagnosis and treatment of these patients and a brief review of the bibliography. We hope it will be helpful for physicians facing similar cases.

La agenesia de la vesícula biliar es una entidad rara en pediatría con una evolución normalmente silente, y representa un desafío diagnóstico para el médico que enfrenta estos casos por primera vez. Algunos pacientes pueden, sin embargo, presentar síntomas que simulan otras patologías del árbol biliar, y muchos de ellos son operados ante esta sospecha. Sin embargo, el diagnóstico oportuno de esta entidad permite llevar a cabo un tratamiento médico que muchas veces es suficiente para resolver el problema del paciente. Si bien es una condición benigna, los pacientes suelen presentar otras malformaciones asociadas que son más graves en naturaleza y que deben investigarse activamente para poder derivarlos a los especialistas de manera oportuna. Presentamos nuestra experiencia en el diagnóstico y tratamiento de estos pacientes, así como una breve revisión de la literatura. Esperamos que sea de utilidad para el médico que encuentre un caso similar.

Variación anatómica de la vía biliar tipo F de Blumgart / Anatomical variation of Blumgart´s F type bile duct / Variacão anatômica do ducto biliar do tipo F de Blumgart

Se presenta el caso de una paciente de 40 años portadora de litiasis biliar sintomática que se operó de coordinación por abordaje laparoscópico

Metastatic gallbladder carcinoma presenting as an ovarian mass

Metastatic gallbladder carcinoma to the ovaries is occasional but a recognized entity. It can mimic, clinical and morphologically, a primary ovarian tumor, challenging the diagnosis. We present the case of a patient with a lump in the hypogastrium extending into the right iliac fossa and was found to have abdominopelvic cystic lesion with enhancing solid components and multiple sub-centimetric and ill-defined abdominal lymph nodes. Also, subpleural and parenchymal nodules in the lungs were present. She subsequently underwent a laparotomy. Cholecystectomy was also done due to pre-existing symptomatic biliary lithiasis. The histologic report described the ovarian involvement as metastases from a gallbladder carcinoma. The presentation of ovarian metastases can challenge the diagnosis. Hence, careful evaluation of the digestive tract and judicious use of immunohistochemistry should be considered in patients presenting with ovarian masses.

Adenomyomatosis of the gallbladder in an adolescent, a very rare condition. / Adenomiomatosis vesicular en un adolescente, una afección muy rara.

Adenomyomatosis of the gallbladder is an acquired, degenerative disease characterized by epithelial proliferation with hypertrophy of the muscularis layer with forming of sinus tracts, termed Rokitansky-Aschoff sinuses. Adenomyomatosis is diagnosed mainly by ultrasonography. The pathogenesis, pathology, and indications for surgery in this condition are not well understood. It is an extremely rare condition in children. We present a case of a 17-year boy with adenomyomatosis of the gallbladder successfully managed with laparoscopic cholecystectomy.

La adenomiomatosis vesicular es una enfermedad degenerativa adquirida que se caracteriza por proliferación epitelial con hipertrofia de la capa muscular y formación de trayectos fistulosos, conocidos como senos de Rokitansky-Aschoff. La adenomiomatosis se diagnostica principalmente mediante ecografía. No se conocen cabalmente la patogenia, la patología ni las indicaciones para cirugía de esta afección. Es sumamente rara en niños. En este artículo, presentamos el caso de un varón de 17 años con adenomiomatosis vesicular tratado adecuadamente con una colecistectomía laparoscópica.

Diagnóstico e tratamento de mucocele da vesícula biliar em cão / Diagnosis and treatment of gall bladder mucocele in dog

A mucocele de vesícula biliar se caracteriza pelo acúmulo anormal de bile semissólida na vesícula biliar. O presente trabalho relata o caso de uma cadela idosa, da raça yorkshire atendida em um Hospital Veterinário particular (Serviço Médico Veterinário SEMEVE), com quadro de vômitos, anorexia, prostração e tremores, iniciados no dia do atendimento. Durante a anamnese, a tutora relatou que a paciente tinha sido diagnosticada há três anos com dislipidemia, sendo descartadas afecções endócrinas como causa do quadro. Ao exame físico, o animal apresentava sensibilidade à palpação abdominal e discreta icterícia em esclera. Durante o ultrassom de abdômen foi diagnosticada a mucocele de vesícula biliar, através da ecogenicidade, padrão apresentado pela bile e histórico clínico do animal. O tratamento inicial foi com antibioticoterapia, fluidoterapia suplementada com vitamina b e potássio, analgésico, antiemético e protetor gástrico. Devido a piora do quadro apresentada nos exames, 48 horas após o internamento, foi realizada colecistectomia. No transcirúrgico identificou-se aderência do omento à vesícula biliar e líquido ao redor dela. Foi realizada cultura com antibiograma da bile e mantida a terapia alopática. O histopatológico da vesícula biliar apontou colecistite aguda supurada. A cultura isolou a bactéria Sthapylococcus intermedius. Após 60 dias de realizada a cirurgia, o animal encontrava-se clinicamente saudável e como os exames para controle apontaram resolução completa das alterações, foi dada alta médica.(AU)

The gallbladder mucocele (GBM) is characterized by abnormal accumulation of semisolid bile in the gallbladder. This case repor is about a female dog, Yorkshire, attended on a private Veterinary Hospital (Serviço Médico Veterinário SEMEVE). The dog had vomiting, anorexia, prostration and tremors that started on the day of the appointment. During the anamnesis, the tutor reported that the patient had been diagnosed with dyslipidemia three years before, however, endocrine disorders were ruled out as the cause of the condition. At the physical examination, the animal presented sensitivity to abdominal palpation and mild sclera jaundice. During the abdominal ultrasound it was diagnosed gallbladder mucocele, through echogenicity and the pattern presented by the bile associated with the clinical history of the animal. The initial treatment was with antibiotic therapy, fluid therapy supplemented with vitamin B and potassium, analgesic, antiemetic and gastric protector. Due to the worsening of the dog seen in the exams, 48 hours after admission, cholecystectomy was performed. In the transurgical procedure, omentum adherence to the gallbladder and fluid around it was identified. Culture with bile antibiogram was performed and allopathic therapy was maintained. The histopathology of the gallbladder showed acute suppurated cholecystitis. The culture isolated the bacterium Sthapylococcus intermedius. After 60 days of the surgery, the animal was clinically healthy and the tests for control showed complete resolution of the changes, so it was given medical discharge.(AU)

Complete gallbladder duplication: seventh report in world literature

Gallbladder duplication results from a rare abnormality of embriogenesis and is twice as common in women as in men. The signs and symptoms of double gallbladder cholecystitis are the same as those of single gallbladder cholecystitis: strong pain in the epigastric region and right hypochondrium, which may irradiate to the back and be accompanied by nausea and/or vomiting, Murphy positive sign, and pain on palpation of these regions; plastron may also be present. For this reason, many cases are still diagnosed intraoperatively, making surgery difficult and increasing the possibility of biliary tract injury. We report the case of a female patient with epigastric and dorsal pain for 4 days, which worsened with the ingestion of salty and fatty foods and was accompanied by nausea and vomiting. Physical examination showed a positive Murphy sign. A complete abdominal ultrasound examination showed gallbladder duplication, both lithiasic. Magnetic resonance cholangiography confirmed the duplication of the gallbladder and cystic ducts, with a single main biliary tract and acute lithiasic cholecystitis in both gallbladders. A laparoscopic cholecystectomy of both vesicles was performed without complications, and the patient was discharged 3 days after the procedure. (AU)

Diagnóstico e tratamento de mucocele da vesícula biliar em cão / Diagnosis and treatment of gall bladder mucocele in dog

A mucocele de vesícula biliar se caracteriza pelo acúmulo anormal de bile semissólida na vesícula biliar. O presente trabalho relata o caso de uma cadela idosa, da raça yorkshire atendida em um Hospital Veterinário particular (Serviço Médico Veterinário – SEMEVE), com quadro de vômitos, anorexia, prostração e tremores, iniciados no dia do atendimento. Durante a anamnese, a tutora relatou que a paciente tinha sido diagnosticada há três anos com dislipidemia, sendo descartadas afecções endócrinas como causa do quadro. Ao exame físico, o animal apresentava sensibilidade à palpação abdominal e discreta icterícia em esclera. Durante o ultrassom de abdômen foi diagnosticada a mucocele de vesícula biliar, através da ecogenicidade, padrão apresentado pela bile e histórico clínico do animal. O tratamento inicial foi com antibioticoterapia, fluidoterapia suplementada com vitamina b e potássio, analgésico, antiemético e protetor gástrico. Devido a piora do quadro apresentada nos exames, 48 horas após o internamento, foi realizada colecistectomia. No transcirúrgico identificou-se aderência do omento à vesícula biliar e líquido ao redor dela. Foi realizada cultura com antibiograma da bile e mantida a terapia alopática. O histopatológico da vesícula biliar apontou colecistite aguda supurada. A cultura isolou a bactéria Sthapylococcus intermedius. Após 60 dias de realizada a cirurgia, o animal encontrava-se clinicamente saudável e como os exames para controle apontaram resolução completa das alterações, foi dada alta médica.

The gallbladder mucocele (GBM) is characterized by abnormal accumulation of semisolid bile in the gallbladder. This case repor is about a female dog, Yorkshire, attended on a private Veterinary Hospital (Serviço Médico Veterinário – SEMEVE). The dog had vomiting, anorexia, prostration and tremors that started on the day of the appointment. During the anamnesis, the tutor reported that the patient had been diagnosed with dyslipidemia three years before, however, endocrine disorders were ruled out as the cause of the condition. At the physical examination, the animal presented sensitivity to abdominal palpation and mild sclera jaundice. During the abdominal ultrasound it was diagnosed gallbladder mucocele, through echogenicity and the pattern presented by the bile associated with the clinical history of the animal. The initial treatment was with antibiotic therapy, fluid therapy supplemented with vitamin B and potassium, analgesic, antiemetic and gastric protector. Due to the worsening of the dog seen in the exams, 48 hours after admission, cholecystectomy was performed. In the transurgical procedure, omentum adherence to the gallbladder and fluid around it was identified. Culture with bile antibiogram was performed and allopathic therapy was maintained. The histopathology of the gallbladder showed acute suppurated cholecystitis. The culture isolated the bacterium Sthapylococcus intermedius. After 60 days of the surgery, the animal was clinically healthy and the tests for control showed complete resolution of the changes, so it was given medical discharge.

A Duplicated Gallbladder in a Patient Presenting with Acute Cholangitis. A Case Study and a Literature Review.

Gallbladder duplication can present a clinical challenge primarily due to difficulties with diagnosis and identification. Recognition of this anomaly and its various types is important since it can complicate a gallbladder disease or a simple hepatobiliary surgical procedure. The case report of a 63-year-old woman who presented with cholangitis and underwent a successful laparoscopic management of symptomatic gallbladder duplication is described, emphasizing several important considerations. Using ERCP, MRCP and 3D reconstructions the two cystic ducts with one common bile duct were identified. A review of the literature in referral of this variant, its anatomical classifications and significance to clinical and surgical practice is included. In conclusion, gallbladder anomalies should be anticipated in the presence of a cystic lesion reported around the gallbladder when evaluating radiologic studies. In case of surgery, preoperative diagnosis is essential to prevent possible biliary injuries or reoperation if accessory gallbladder has been overlooked during initial surgery. Laparoscopic cholecystectomy remains feasible for intervention can be safely done and awareness is necessary to avoid complications or multiple procedures.

Colangitis crónica asociada a la infestación por trematodo hepático causado por Platynosomum fastosum, concurrente con la duplicación de la vesícula biliar en el gato doméstico: presentación de un caso / Chronic cholangitis associated with liver fluke infestation caused by Platynosomum fastosum, concurrent with gallbladder duplication in a domestic cat: case report / Colangite crônica associada à infestação de trematódeo por Platynosomum fastosum, concomitante à vesícula biliar dupla em um gato: relato de caso

Este trabajo pretende informar un caso de un felino de cinco años mestizo, presentando intensa ictericia, petequias y equimosis cutánea generalizada, aumento de enzima ALT, aumento del colesterol sérico y disminución de las proteínas plasmáticas. Se instituyó el tratamiento médico, pero el animal murió dos días después de la intervención clínica. El examen histopatológico mostró colangitis crónica asociada con infestación por trematodos Platynosomum fastosumy verdadera duplicación de la vesícula biliar. Se conclui que los cambios anatómicos asociados con la infestación por parásitos pueden agravar significativamente el cuadro clínico de colangitis crónica y siempre debe ser considerado en el plan de diagnóstico.(AU)

This paper aims to report a case of a 5-years-old, mixed breed cat showing severe jaundice, skin petechiae and ecchymosis, high values of ALT enzyme and serum cholesterol and low plasmatic proteins. A medical treatment was instituted; however the animal died two days after clinical intervention. Anatomicopathological analisys showed a chronic cholangitis associated with liver fluke infestation caused by Platynosomum fastosum, and duplex gallbladder. We conclude that anatomical changes associated with infestation by parasites may significantly aggravate the clinical condition of chronic cholangitis and should always be considered in the diagnostic plan.(AU)

Este trabalho tem o objetivo de relatar um caso de um felino de cinco anos, sem raça definida, apresentando icterícia intensa, petéquias e equimoses cutâneas generalizadas, aumento da enzima ALT, aumento de colesterol sérico e diminuição de proteínas plasmáticas. Foi instituído tratamento médico, entretanto o animal morreu dois dias após a intervenção clínica. No exame anatomopatológico observou-se colangite crônica associada à infestação de trematódeo Platynosomum fastosum e vesícula biliar dupla verdadeira. Conclui-se que alterações anatômicas associadas à infestação por parasitas podem agravar significativamente o quadro clínico de colangite crônica e devem sempre ser consideradas no plano diagnóstico.(AU)

Colangitis crónica asociada a la infestación por trematodo hepático causado por Platynosomum fastosum, concurrente con la duplicación de la vesícula biliar en el gato doméstico: presentación de un caso / Chronic cholangitis associated with liver fluke infestation caused by Platynosomum fastosum, concurrent with gallbladder duplication in a domestic cat: case report / Colangite crônica associada à infestação de trematódeo por Platynosomum fastosum, concomitante à vesícula biliar dupla em um gato: relato de caso

Este trabajo pretende informar un caso de un felino de cinco años mestizo, presentando intensa ictericia, petequias y equimosis cutánea generalizada, aumento de enzima ALT, aumento del colesterol sérico y disminución de las proteínas plasmáticas. Se instituyó el tratamiento médico, pero el animal murió dos días después de la intervención clínica. El examen histopatológico mostró colangitis crónica asociada con infestación por trematodos Platynosomum fastosumy verdadera duplicación de la vesícula biliar. Se conclui que los cambios anatómicos asociados con la infestación por parásitos pueden agravar significativamente el cuadro clínico de colangitis crónica y siempre debe ser considerado en el plan de diagnóstico.

This paper aims to report a case of a 5-years-old, mixed breed cat showing severe jaundice, skin petechiae and ecchymosis, high values of ALT enzyme and serum cholesterol and low plasmatic proteins. A medical treatment was instituted; however the animal died two days after clinical intervention. Anatomicopathological analisys showed a chronic cholangitis associated with liver fluke infestation caused by Platynosomum fastosum, and duplex gallbladder. We conclude that anatomical changes associated with infestation by parasites may significantly aggravate the clinical condition of chronic cholangitis and should always be considered in the diagnostic plan.

Este trabalho tem o objetivo de relatar um caso de um felino de cinco anos, sem raça definida, apresentando icterícia intensa, petéquias e equimoses cutâneas generalizadas, aumento da enzima ALT, aumento de colesterol sérico e diminuição de proteínas plasmáticas. Foi instituído tratamento médico, entretanto o animal morreu dois dias após a intervenção clínica. No exame anatomopatológico observou-se colangite crônica associada à infestação de trematódeo Platynosomum fastosum e vesícula biliar dupla verdadeira. Conclui-se que alterações anatômicas associadas à infestação por parasitas podem agravar significativamente o quadro clínico de colangite crônica e devem sempre ser consideradas no plano diagnóstico.

Agenesia de la Vesícula Biliar asociada a pancreatitis aguda recurrente. Presentación de caso / Gall bladder agenesis associated with recurrent acute pancreatitis. Case presentation

Introducción: La Agenesia de la Vesícula Biliar es una anomalía congénita rara, entre 13 y 65 por ciento por cada 100 000 habitantes. Su asociación con pancreatitis aguda es extremadamente rara. Objetivo: Presentar un caso de Agenesia de la Vesícula Biliar asociada a pancreatitis aguda recurrente.Presentación del caso: Se presenta una mujer de 85 años, con antecedentes de litiasis vesicular por ultrasonido (US), y crisis de dolor abdominal, vómitos e hipotensión frecuentes, a quien remitían con tratamiento médico. Acudió al hospital con dolor abdominal, vómitos e hipotensión. Al examen físico se constató: dolor epigástrico, sin reacción peritoneal ni tumor palpable. El US informó vesícula no visible. En menos de 24 horas evolucionó con shock, disfunción múltiple de órganos y muerte. En la necropsia se encontró Agenesia de la Vesícula Biliar (AVB) y pancreatitis aguda necrotizante. Conclusiones: La AVB es una anomalía congénita rara, de difícil diagnóstico preoperatorio, por lo que casi siempre es un hallazgo de la cirugía abdominal o en la autopsia. Su asociación con pancreatitis aguda es rara. La pancreatitis puede ser debida a Disfunción del Esfínter de Oddi o de origen idiopático(AU)

Introduction: Gallbladder agenesis (GA) is a rare congenital anomaly, with a reported incidence ranging between 13-65 percent per a 100 000 population. Its association with acute pancreatitis is extremely rare. Objective: To present a case of GA associated with recurrent acute pancreatitis. Case Presentation: We present an 85 years old woman whose clinical record reported a bladder stonediagnosis by US, that arrive to the hospital with frequent episodes of intermittent vomiting, abdominal pain and hypotension. She was admitted at hospital with upper abdominal pain, vomiting and hypotension. At the physical examination the abdomen was soft, with mild epigastric tenderness, without tenderness rebound or tumor. US report gallbladder not visible. In less than 24 hours the patient evolved with shock, multiple organ failure and death. Gallbladder agenesis and acute pancreatitis were found in autopsy. Conclusions: The GA is a rare congenital anomaly, difficult to establish a correct preoperative diagnosis, always found during the abdominal surgery or autopsy. Its association with acute pancreatitis is very uncommon. Pancreatitis may be due to of Oddi Sphincter's Dysfunction (SOD) or idiopathic origin(AU)

Agenesia de la Vesícula Biliar asociada a pancreatitis aguda recurrente. Presentación de caso / Gall bladder agenesis associated with recurrent acute pancreatitis. Case presentation

Introducción: La Agenesia de la Vesícula Biliar es una anomalía congénita rara, entre 13 y 65 por ciento por cada 100 000 habitantes. Su asociación con pancreatitis aguda es extremadamente rara. Objetivo: Presentar un caso de Agenesia de la Vesícula Biliar asociada a pancreatitis aguda recurrente. Presentación del caso: Se presenta una mujer de 85 años, con antecedentes de litiasis vesicular por ultrasonido (US), y crisis de dolor abdominal, vómitos e hipotensión frecuentes, a quien remitían con tratamiento médico. Acudió al hospital con dolor abdominal, vómitos e hipotensión. Al examen físico se constató: dolor epigástrico, sin reacción peritoneal ni tumor palpable. El US informó vesícula no visible. En menos de 24 horas evolucionó con shock, disfunción múltiple de órganos y muerte. En la necropsia se encontró Agenesia de la Vesícula Biliar (AVB) y pancreatitis aguda necrotizante. Conclusiones: La AVB es una anomalía congénita rara, de difícil diagnóstico preoperatorio, por lo que casi siempre es un hallazgo de la cirugía abdominal o en la autopsia. Su asociación con pancreatitis aguda es rara. La pancreatitis puede ser debida a Disfunción del Esfínter de Oddi o de origen idiopático(AU)

Introduction: Gallbladder agenesis (GA) is a rare congenital anomaly, with a reported incidence ranging between 13-65 percent a 100 000 population. Its association with acute pancreatitis is extremely rare. Objective: To present a case of GA associated with recurrent acute pancreatitis. Case Presentation: We present an 85 years old woman whose clinical record reported a bladder stonediagnosis by US, that arrive to the hospital with frequent episodes of intermittent vomiting, abdominal pain and hypotension. She was admitted at hospital with upper abdominal pain, vomiting and hypotension. At the physical examination the abdomen was soft, with mild epigastric tenderness, without tenderness rebound or tumor. US report gallbladder not visible. In less than 24 hours the patient evolved with shock, multiple organ failure and death. Gallbladder agenesis and acute pancreatitis were found in autopsy. Conclusions: The GA is a rare congenital anomaly, difficult to establish a correct preoperative diagnosis, always found during the abdominal surgery or autopsy. Its association with acute pancreatitis is very uncommon. Pancreatitis may be due to of Oddi Sphincter's Dysfunction (SOD) or idiopathic origin(AU)

Duplicación de la vesícula biliar / Gallbladder duplication

Gallbladder duplication is a rare congenital anomaly and, like other biliary malformations, is associated with an increased risk of complications in the laparoscopic cholecystectomy We present a case of a woman consulting in the emergency department for clinical symptoms compatible with acute cholecystitis. An abdominal ultrasound is performed confirming the clinical suspicions, observing the typical findings. Pathological dilatation of the extrahepatic biliary tract is also confirmed, therefore she is evaluated with MR cholangiography, which also confirms signs compatible with acute cholecystitis; the presence of a cystic formation of saccular morphology in an intrahepatic location was identified, with the same structure as the gallbladder, but smaller in size and with a duct of its own that drained into the common hepatic duct independently to the cystic duct of the inflamed vesicle.

La duplicación de la vesícula biliar es una anomalía del desarrollo poco frecuente, y al igual que otras malformaciones de la vía biliar, se asocia a un mayor riesgo de complicaciones en la colecis-tectomía laparoscópica. Se presenta un caso de una mujer que consulta en el servicio de urgencia por cuadro clínico compatible con colecistitis aguda. Se realiza una ecografía abdominal que confirma la presunción clínica, observándose los hallazgos típicos. Se constata además dilatación patológica de la vía biliar extrahepática, por lo que se evalúa con colangiorresonancia, que además de confirmar los signos compatibles con la colecistitis aguda, se identificó la presencia de una formación quística de morfología sacular en situación intrahepática, de igual morfología que la vesícula biliar, pero de menor tamaño y con un conducto propio que drenaba al conducto hepático común en forma independiente al conducto cístico de la vesícula inflamada.

Agenesia de vesícula biliar: presentación de caso y revisión de la literatura / Gallbladder agenesis: case report and a literature review

La agenesia de vesícula biliar es una enfermedad rara cuya sintomatología emula patología biliar. Está presente entre el 0,007 al 0,027% de aquellos en quienes se practica una colecistectomía. Luego de la misma, su evolución es asintomática. Se presenta el caso de una paciente femenina de 19 años con cuadro clínico compatible con colelitiasis. La ecografía revela vesícula escleroatrófica. Se realizó colecistectomía electiva, sin hallarse vesícula biliar. Tanto en el posoperatorio, como en el seguimiento anual, el curso fue asintomático. Además, se realizó una revisión de casos a partir de publicaciones de casos clínicos obtenidos de Medline. Catorce pacientes fueron incluidos en la revisión de casos, comparándose con otros cinco estudiados en una serie de casos. No existió diferencia significativa entre ambos grupos. La agenesia de vesícula biliar se presenta comúnmente entre los 40 y 64 años, con dolor en cuadrante superior derecho y diagnóstico ecográfico de colelitiasis. Es poco probable llegar a un diagnóstico preoperatorio. De intervenirse, es preferible limitarse a la exploración laparoscópica. La evolución ulterior será asintomática, sin estar claro aún el por qué.

Gallbladder agenesis is a rare disease, which its symptomatology emulates biliary pathology. It is presented between 0.007 to 0.027% of those patients in whom a cholecystectomy is performed. After it, its evolution is asymptomatic. We present the case of a 19 years old female patient with clinical presentationof cholelithiasis. Ultrasound reveals scleroatrophic vesicle. Elective cholecystectomy was performed,but the gallbladder was not found. The patient presented an asymptomatic evolution in the postoperative period and in the annual follow-up. In addition, we performed a case review from clinical case reports obtained from Medline. Fourteen patients were included in the review of cases, compared to another five studied in a series of cases. There was no significant difference between the two groups. Gallbladder agenesis usually happens between 40 and 64 years, with pain in the upper right quadrant and ultrasound diagnosis of cholelithiasis. It is unlikely to reach a preoperative diagnosis. If it is intervened, it is preferable to limit to laparoscopic examination. The following evolution will be asymptomatic, althoughthe cause of it is not known yet.

[Gallbladder agenesis: case report and a literature review]. / Agenesia de vesícula biliar: presentación de caso y revisión de la literatura.

Gallbladder agenesis is a rare disease, which its symptomatology emulates biliary pathology. It is presented between 0.007 to 0.027% of those patients in whom a cholecystectomy is performed. After it, its evolution is asymptomatic. We present the case of a 19 years old female patient with clinical presentationof cholelithiasis. Ultrasound reveals scleroatrophic vesicle. Elective cholecystectomy was performed,but the gallbladder was not found. The patient presented an asymptomatic evolution in the postoperative period and in the annual follow-up. In addition, we performed a case review from clinical case reports obtained from Medline. Fourteen patients were included in the review of cases, compared to another five studied in a series of cases. There was no significant difference between the two groups. Gallbladder agenesis usually happens between 40 and 64 years, with pain in the upper right quadrant and ultrasound diagnosis of cholelithiasis. It is unlikely to reach a preoperative diagnosis. If it is intervened, it is preferable to limit to laparoscopic examination. The following evolution will be asymptomatic, althoughthe cause of it is not known yet.

Agenesia del lóbulo hepático derecho asociado a agenesia vesicular / Agenesis of the right hepatic lobe associated with gallbladder agenesis

Background: Anatomical abnormalities of the liver are rare and their association with gallbladder agenesis are even more uncommon. Case report: We report a 63 years old man complaining of jaundice, without pain or fever. A magnetic resonance imaging showed a right hepatic lobe agenesis associated with gallbladder agenesis. Jaundice subsided spontaneously.

Introducción: Las anomalías anatómicas del hígado son raras, la asociación a una agenesia vesicular es más infrecuente aún, siendo su diagnóstico generalmente un hallazgo. Caso clínico: Presentamos el caso de un paciente masculino de 63 años que consulta por ictericia, sin dolor ni fiebre, al cual se le realiza diagnóstico por imagen con resonancia magnética de agenesia de lóbulo hepático derecho asociado a agenesia vesicular. Dado que el paciente no tiene litiasis biliar, se decide tratamiento médico.

[Gallbladder agenesis. Case report]. / Agenesia de la vesícula biliar. Reporte de caso.

BACKGROUND: Gallbladder agenesis is a very rare congenital abnormality of the biliary tract. The diagnosis is made during surgery, because all preoperative studies have failed to identify this malformation. The purpose of this article is to present a case of gallbladder agenesis diagnosed during surgery, its management, and a review of the literature. CLINICAL CASE: The case involves a sixty-two year- old female, referring to repeated biliary colic symptoms. The abdominal ultrasound diagnosed cholelithiasis. It was impossible to identify the gallbladder during surgery. Diagnosis was confirmed by intra-operative cholangiography. DISCUSSION: Preoperative diagnostic workup has failed to recognise patients with gallbladder agenesis. It is currently recommended to abandon the surgery once this diagnosis is suspected and confirm it by a cholangio-magnetic resonance scan in order to avoid a bile duct injury. CONCLUSIONS: Agenesis of the gallbladder is a rare congenital abnormality of the biliary tree. Every surgeon must keep this rare entity in mind when a "difficult dissection" or an anatomic variant is identified during surgery, and make use of an intra-operative cholangiography, mainly to prevent a bile duct injury.