Agenesis of the gallbladder is rare. Three groups have been identified: those with multiple fetal anomalies, asymptomatic cases, and symptomatic cases. Right upper quadrant pain is present in 90% of the cases, nausea and vomiting in 60%, and jaundice in 35%. Operative strategy is aimed at thorough exploration to locate an aberrant gallbladder. We treated a 72-year-old woman with right upper quadrant pain, nausea, and vomiting but no fever or jaundice. Physical examination revealed right upper quadrant tenderness without rebound. The white blood cell count was 10,300/mm3. Total bilirubin level was 1.6 mg/dL. Ultrasonography revealed one gallstone and an enlarged common bile duct. Laparoscopic cholecystectomy was converted to open technique after failure to locate the gallbladder. On intraoperative cholangiogram, no gallbladder was identified. A T-tube was placed.
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