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born without a gallbladder

  Hello, i am a 35 year old mother of 2. It's been 10 years now that i suffer from what the doctors call "gallbladder attacks".
  I have taken numerous ultrasounds and x-rays, but nothing shows up. One doctor told me that i may have been born without a gallbladder since they cannot see it.I have also taken a nuclear test which supposedly colours my gallbladder so they can see it more clearly, but again, nothing shows up!!!!
  i can have 3 attacks in 1 month and then not experience any for 6 months (they can be felt in the front upper right side of my abdomen and sometimes between my shoulder blades).The attacks come slowly, then become very severe and then suddenly disappear. I have heard that IBS mimics symptoms of gallstone attacks, can that be possible?
  Your advice will be highly appreciated!!!!!
Dear Rosa,
I am sorry to read about your recurrent attacks of abdominal pain.  The gall bladder is a sac-like organ that rests under the right lobe of the liver. Bile made by the liver drains through ducts into the gall bladder where it is stored. During meals the gall bladder contracts and bile is released through another duct called the common bile duct (CBD) into the small bowel where it is involved in fat digestion.  Gall bladder pain can be due to inflammation of the gall bladder or blockage of the ducts due to stones.
If the gall bladder is not seen on the nuclear scan, it can indicate a problem with secretion of the isotope by the liver or obstruction of the duct by which bile enters and leaves the gall bladder. In these cases the gall bladder is seen by ultrasound study, which is not so in your case. This raises two possibilities. Either you do not have a gall bladder or the gall bladder  is not where it is supposed to be.
Absence of the gall bladder is a rare congenital condition. It is usually associated with other malformations of the gastrointestinal tract or stenosis of the bile ducts. Patients with cystic fibrosis may have tiny gall bladders. Rarely, patients may just have isolated absence of the gall bladder without any other malformations. This last possibility may be the explanation in your case since you have not described any other diseases.
Sometimes. the gall bladder is not located where it is supposed to be. Instead of being under the right lobe of the liver, the gall bladder may be hidden under the left lobe, maybe in the substance of the liver or may be interposed between the liver and the large intestine. A directed study looking for this malposition may find the gall bladder. A good non-invasive test to look for the gallbladder and to evaluate the bile ducts would be an MRCP (magnetic resonance cholangiopancreatography).
It is difficult to provide a diagnosis over the Internet.  IBS can cause a pain similar to that which you describe.  Inflammatory bowel disease is possible but an unlikely explanation for your symptoms.  Ulcer disease and pancreatic disease must also be excluded.
This information is presented for educational purposes only.  I would recommend that you meet with a doctor who is an expert in biliary diseases. He/she may be able to sort out the possible causes for your pain.  If you prefer, we can arrange for you to be seen by one of our experts in biliary disease at Henry Ford Hospital. Please call our Henry Ford Physician Referral Line at (800)653-6568 to arrange an appoinment with Dr. Ben-Menahem one of our experts in the complexities of gall bladder disease.
*keywords: abdominal pain, gall bladder

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