title: Gallbladder agenesis with a primary choledochal stone in a patient with situs inversus totalis.
abstract: METHODS
  Female, 68 FINAL DIAGNOSIS: Gallbladder agenesis with situs inversus totalis Symptoms: Epigastric pain • jaundice
  
  
  METHODS
  - Clinical Procedure: - Specialty: Surgery.
  
  
  OBJECTIVE
  Rare disease.
  
  
  BACKGROUND
  Situs inversus totalis is an inherited condition characterized by the mirror-image transposition of thoracic and abdominal organs. Gallbladder agenesis, which has normal bile ducts, is a rare congenital condition that occurs in 13 to 65 people out of 100 000. A common bile duct (CBD) stone or choledocholithiasis in patients with gallbladder agenesis is even rarer.
  
  
  METHODS
  We report the case of a 68-year-old woman who presented with epigastric pain and jaundice. She was not known to have situs inversus totalis. Abdominal ultrasound showed a large stone in the CBD, which could not be extracted by endoscopic retrograde cholangiopancreatography (ERCP), necessitating exploration. The gall-bladder and cystic duct were found to be absent. Incisional exploration of the CBD was performed, and a large stone was removed. A choledochoscope was used to identify the remnants and exclude the presence of ectopic gallbladder, and a T-tube was placed into the CBD.
  
  
  CONCLUSIONS
  Gallbladder agenesis in a patient with situs inversus totalis is extremely rare, with no single reported case identified in the literature. In addition, our case showed a rare complication of ERCP - a failure to extract the CBD stone - and illustrates a way to overcome this complication.
authors.affiliation: Department of Surgery, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors.forename: Hassan A
authors.initials: HA
authors.lastname: Alzahrani
authors.affiliation: Department of Surgery, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors.forename: Nizar M
authors.initials: NM
authors.lastname: Yamani
keywords: Choledocholithiasis; Gallbladder; Situs Inversus