Mohammed Ayad Ahmad, Arif Sardar Hassan
Department of Surgery, College of Medicine, University of Duhok, Kurdistan Region, Iraq.
Department of Surgery, College of Medicine, University of Duhok, Kurdistan Region, Iraq.
Int J Surg Case Rep. 2021 May;82:105875. doi: 10.1016/j.ijscr.2021.105875. Epub 2021 Apr 7.
Anomalies of the biliary system are frequently encountered. Agenesis of the gall bladder is a rare. The exact incidence is not known as most cases are asymptomatic and diagnosed incidentally during surgeries for unrelated conditions or at autopsy. This anomaly may occur alone or in association with other anomalies such as other biliary anomalies, portal vein anomalies and other vascular anomalies, or in some cases hepatic, gastrointestinal or anomalies in other body systems.
An elderly man diagnoses with segment VI liver tumor and planned for surgical resection. During surgery we accidentally discovered gall bladder agenesis with slightly dilated common bile duct. The tumor resected successfully and the final diagnosis was well differentiated with hepatocellular carcinoma.
Careful search for the gall bladder must be done before diagnosing agenesis of the gall bladder. No conversion is required provided adequate visualization and search for the gall bladder is done during laparoscopy. Postoperative MCRP will define the biliary anatomy and to help the surgeons to have postoperative accurate decision.
胆道系统异常较为常见。胆囊缺如则较为罕见。确切发病率尚不清楚，因为大多数病例无症状，是在因其他无关疾病进行手术时或尸检时偶然发现的。这种异常可能单独出现，或与其他异常同时存在，如其他胆道异常、门静脉异常和其他血管异常，或在某些情况下与肝脏、胃肠道或其他身体系统的异常同时存在。
一名老年男性被诊断为肝Ⅵ段肿瘤并计划进行手术切除。手术过程中，我们意外发现胆囊缺如，胆总管轻度扩张。肿瘤被成功切除，最终诊断为高分化肝细胞癌。
在诊断胆囊缺如之前，必须仔细寻找胆囊。如果在腹腔镜检查期间能够充分观察并找到胆囊，则无需改变手术方式。术后磁共振胆胰管造影（MCRP）将明确胆道解剖结构，有助于外科医生做出准确的术后决策。
