Incidental Isolated Bilateral Clavicular Agenesis Discovered During Preoperative Hernia Assessment of a 78-Year-Old Male in Rural Uganda: A Case Report.

BACKGROUND: Bilateral agenesis of the clavicles is an extremely rare congenital anomaly. It is most commonly associated with cleidocranial dysplasia, an autosomal dominant skeletal disorder characterized by delayed closure of cranial sutures, dental anomalies, and hypoplastic or aplastic clavicles. Diagnosis typically occurs in childhood. We report a rare case of a 78-year-old male diagnosed incidentally with bilateral clavicular agenesis during a routine preoperative workup for a recurrent inguinal hernia.

CASE PRESENTATION: A 78-year-old African male presented with a recurrent left inguinal hernia. His medical history was significant for hypertension and a previous hernioplasty 10 years prior. During routine preoperative physical examination and chest radiography, a complete bilateral absence of the clavicles was noted. The patient had hypermobility of the shoulder girdle but reported no functional impairment throughout his 78 years of life. He successfully underwent a left inguinal hernioplasty under spinal anesthesia and had an uneventful recovery.

CONCLUSION: Complete bilateral clavicular agenesis can remain entirely asymptomatic and functionally benign into late adulthood, allowing for unhindered manual labor. In low-resource settings, routine preoperative radiography for unrelated conditions serves as a vital diagnostic tool for uncovering such latent congenital anomalies.