A ghost gallbladder. An unusual case of gallbladder agenesia from a clinical and medico-legal point of view

Matteo Bolcato¹, Matteo Sanavio¹, Anna Aprile¹, Andrea Piccioni², Marco Trabucco Aurilio³

¹Legal Medicine,  Department of Molecular Medicine, Legal Medicine, University of Padua, Padua, Italy - ²Emergency Medicine Department, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy - ³Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy

Introduction: Congenital agenesis of the gallbladder is an uncommon anatomical variation. This congenital disease is usually asymptomatic, although some affected individuals may have a clinical picture suggesting gallbladder disease. 

Case presentation: A 31-year-old woman entered the emergency room with nonspecific abdominal symptoms, compatible with a gallbladder disease. The patient underwent many ultrasounds and an MRI cholangiography that did not display the gallbladder. Despite the negative results, doctors suspected lithasic cholecystitis, due to persistent symptoms, and suggested a laparoscopic cholecystectomy. However, after converting the surgery to laparotomy and performing an intraoperative cholangiography, surgeons diagnosed a gallbladder agenesis. 

Conclusion: The present case raises two interesting medico-legal issues related to surgical indication and informed consent. Clinical knowledge of this case and the medico-legal implications can be useful to any healthcare professional in order to increase the safety of treatments and prevent adverse events.