Gallbladder agenesis with midgut malrotation.

A 28-year-old female presented with a 4 year history of intermittent right upper quadrant pain. Clinical examination and ultrasound suggested a diagnosis of cholelithiasis and the patient was eventually booked for a laparoscopic cholecystectomy. Intraoperatively the patient was found to have gallbladder agenesis and small bowel malrotation with the duodenojejunal flexure to right of midline. The gallbladder fossa was filled with fibrous tissue. Both gallbladder agenesis and midgut malrotation are rare congenital abnormalities. Gallbladder agenesis has a similar presentation to more common gallbladder pathologies, such as cholecystitis. This case illustrates the limitations of and our over reliance on radiological imaging. Moreover, it highlights the need to have a high index suspicion of gallbladder agenesis when ultrasound is inconclusive. Further investigations and imaging with modalities such as MRI should be used to reduce the risks associated with unnecessary surgical intervention.