Absence of a gallbladder does not always mean a cholecystectomy

摘要

A 65-year-oid woman with a history of hypertension presented with chills and right upper abdominal quadrant pain. She reported no history of abdominal surgery and specifically denied cholecystectomy. On physical examination, there was significant right upper quadrant tenderness as well as minimal conjunctival icterus; no surgical scar was present. The patient was afebrile, with an admission temperature of 36.8°C. Laboratory test analysis revealed leukocytosis of 12,800/mm~3 (normal 4000-10,8000 mm3), total bilirubin 2.1 mg/dL (0.2-1.3 mg/dL), direct bilirubin of 1.8 mg/dL (<0.3 mg/dL), and alkaline phos-phatase of 180 U/L (38-126 U/L). Magnetic resonance cholangiopancreatography demonstrated choledocholithi-asis with biliary tree dilatation to 1.3 cm. Additionally noted was a cystic duct remnant without a gallbladder, suggesting prior cholecystectomy (A). ERCP demonstrated dilated intrahepatic and extrahepatic ducts.