Abstract

DEVELOPMENTAL MALFORMATION OF THE GALLBLADDER DETECTED DURING SURGERY-AN OBSERVATION

Dr. Abhijit Sarma and Dr. Purujit Choudhury*

ABSTRACT

BACKGROUND: Embryologically, gallbladder is developed from pars cystic of ventral duodenal bud. During its rotation in clockwise direction towards dorsal bud, it fails to give rise to develop gallbladder or its different parts. But it is a very rare anomaly. Incidence is 1 in 1000. Gallbladder agenesis is an isolated finding in more than two-thirds (70%) of people. The person with isolated gallbladder agenesis is healthy. No treatment is needed and the prognosis is excellent. The aim of this study is to describe the clinical profile of patients with agenesis of gall bladder. MATERIALS AND METHODS: It is a descriptive study. Twenty two patients of agenesis of gallbladder admitted at GMC between 2009 - 2017 were studied in a descriptive way that was carried out at Gauhati Medical College with the help of much skilled and experienced surgeons in laparoscopic surgical procedure. This type of congenital anomalies of biliary tree and very particularly absent or agenesis of gallbladder can be managed by the aid of laparoscopic procedure itself without any difficulties, which is the accepted procedure of choice in comparison to laparotomy. But laparotomy was usually used to adopt in the past and by inexperienced surgeon in this field and the center where laparoscopic and laparoscopic ultrasound are not at all available. By accepting this procedure of laparoscopy, morbidity and different probable complications following open procedure can be minimised considerably. Most of the patients had typical right hypochondriac pain, which was colicky and referred to right shoulder and back, off and on vomiting, nausea and flatulent dyspepsia. The clinical features suggestive of gallstone diseases which were further confirmed by transabdominal ultrasonography and depicted very small contracted gallbladder with few stones having its posterior acoustic shadow. RESULTS: Gallbladder was found to be absent during initial diagnostic laparoscopic assessment of intraperitoneal organs in all the patients resulting in conversion to exploratory laparotomy in five patients. Gaining much confidence on laparoscopic surgery, the other patients of congenital agenesis of gallbladder were able to diagnose exclusively by conventional laparoscopic means to have the developmental defect like agenesis of gallbladder. But with much experience and skill in hand, instead of conversion it was able to do by laparoscopic only and further confirmed by post-operative imaging evaluation. CONCLUSION: Congenital absent or developmental defect like agenesis of gall bladder is very uncommon. With much confidence in laparoscopic surgery, the condition no longer becomes mandatory for the procedure to be converted to laparotomy for finalising its diagnosis. All the patients showed sign of improvement after surgery.

Keywords: Congenital Gall Bladder Agenesis, Laparoscopic Cholecystectomy, Laparotomy.