Agenesis of the gallbladder with hypoplastic cystic duct diagnosed at laparoscopy
Agenesis of the gallbladder with hypoplastic cystic duct diagnosed at laparoscopy
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DOI：
10.1097/00129689-200608000-00012
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发表时间：
2006-08-01
影响因子：
1
通讯作者：
Imamura, Atsushi
中科院分区：
文献类型：
--
作者：
Kwon, A-Hon;Yanagimoto, Hiroaki;Imamura, Atsushi
一位86岁男性因主诉间歇性上腹痛而住进我科。腹部超声检查显示扩张的肝外胆管内含有结石，但不能清楚地识别胆囊壁。磁共振胆胰管成像显示肝外胆管扩张，胆总管结石，未见胆囊影。取石术采用内窥镜下括约肌切开术。静脉注射胆道造影术后使用螺旋计算机断层扫描的三维图像清楚地显示了胆囊管的阻塞。这位病人被安排进行腹腔镜下的胆囊切除术。在腹腔镜术中，未发现肝脏下表面的胆囊窝。尽管使用腹腔镜超声检查了肝内(左侧在小网膜内)、腹膜后、肝后(在镰状韧带内)、十二指肠后和胰腺后区域，但没有发现胆囊。仔细解剖肝十二指肠韧带，发现扩张的肝外胆管和1厘米长的发育不良的胆囊管。胆囊性发育不全通常伴有胆囊管的缺失。本病例为第三例胆囊管未闭或发育不良的胆囊管发育不全的病例。
An 86-year-old man was admitted to our department with complaints of intermittent upper abdominal pain. Ultrasonography of the abdomen showed dilated extrahepatic bile ducts containing stones; however, the gallbladder was not clearly identified. Magnetic resonance cholangiopancreatography showed dilated extrahepatic ducts and choledocholithiasis without gallbladder visualization. The stone extraction was performed with endoscopic sphincferotomy. Three-dimensional images using spiral-computed tomography after intravenous-infusion cholangiography clearly demonstrated an obstruction of the cystic duct. The patient was scheduled for laparoscopic cholecystectomy. At laparoscopy, the gallbladder fossa was not identified on the undersurface of the liver. Despite a thorough examination of the intrahepatic (left-sided within the lesser omentum), retroperitoneal, retrohepatic (within the falciform ligament), retroduodenal, and retropancreatic areas using laparoscopic ultrasonography, the gallbladder was not found. After careful dissection of the hepatoduodenal ligament, the dilated extrahepatic bile duct and a 1-cm length of hypoplastic cystic duct were found. Gallbladder agenesis is usually accompanied by the lack of the cystic duct. The present case is the third report of gallbladder agenesis with a patent or hypoplastic cystic duct.