He described similar

episodes on two previous occasions. On examination of the abdomen, the only abnormality was mild tenderness on palpation over the right upper quadrant. Screening blood tests including liver function tests and serum amylase were within the reference range. His pain settled with analgesia and he was given an outpatient appointment for an upper abdominal ultrasound scan. The gallbladder was poorly seen but the possibility was raised of a contracted gallbladder with multiple stones. Because of continuing minor symptoms, he was GSK126 cell line advised to proceed with elective laparoscopic cholecystectomy. At operation, it was not possible to identify the gallbladder. The appearance of the gallbladder fossa is shown in Figure 1. Magnetic resonance cholangiopancreatography (MRCP) was performed after surgery and showed congenital absence of the cystic duct and gallbladder (Figure 2). An incidental finding was that of pancreas divisum. Agenesis of the gallbladder BYL719 molecular weight is a rare congenital anomaly with an estimated prevalence of between 1 and 10 per 10,000 people in the general population. The anomaly is usually sporadic although there are occasional reports of two affected members within families. Embryologically, the anomaly is presumed to arise because of a defect in the development of the gallbladder

bud that arises from the caudal portion of the hepatic bud. Most patients do not have a cystic duct stump. At surgery, gallbladder agenesis should only be diagnosed after a careful search of ectopic

locations, particularly an intrahepatic or left-sided gallbladder. Intraoperative cholangiography may also be helpful if the bile duct can be readily identified. However, extensive surgical dissection of the area should be avoided as this may result in injury to hilar structures. MRCP either before or after surgery may also be helpful in those patients with uncertain results from ultrasound or computed tomography scans. In the above patient, possible causes for pain include an atypical irritable bowel syndrome, a motility disorder of the sphincter of Oddi and MCE perhaps pancreas divisum. There are also rare reports of agenesis of the gallbladder with primary bile duct stones. Contributed by “
“A woman, aged 64, was investigated because of upper abdominal discomfort. An upper abdominal ultrasound study and computed tomography (CT) scan showed a cystic mass, 3 cm in diameter, in the head of the pancreas. Endoscopic retrograde cholangiopancreatography revealed a cystic lesion in a major branch of the main pancreatic duct. There was also a filling-defect within the cystic lesion and this was confirmed by endoscopic ultrasound. The diagnosis was that of an intraductal papillary mucinous neoplasm of the head of the pancreas.