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PubMed This is a summary of 15 peer-reviewed journal articles Updated
Gastroenterology

Symptoms and Common Misdiagnoses

At a Glance

Even without a gallbladder, you can experience symptoms resembling a gallbladder attack due to bile duct stones or Sphincter of Oddi dysfunction. Ultrasounds frequently misdiagnose gallbladder agenesis because bowel loops in the empty space can mimic a stone-filled, contracted gallbladder.

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It is a medical paradox: how can you feel “gallbladder pain” when you don’t have a gallbladder? For about 50% of people born with gallbladder agenesis, this is a daily reality [1][2]. Understanding why these symptoms occur—and why they are so frequently misdiagnosed—is the first step toward finding relief.

Why You Feel Pain Without a Gallbladder

The symptoms of gallbladder agenesis are often identical to biliary colic—a term for the cramping, upper-right abdominal pain typically caused by gallstones [3][4]. You may also experience nausea, bloating, and indigestion, especially after eating fatty foods [5].

Because the gallbladder isn’t there to cause the problem, the pain usually stems from other parts of your biliary system:

  • Sphincter of Oddi Dysfunction (SOD): The Sphincter of Oddi is a small muscular valve that controls the flow of digestive juices into your small intestine [6]. If this valve doesn’t open or close correctly, pressure can build up in the bile ducts, causing intense pain that mimics a gallbladder attack [6][7].
  • Choledocholithiasis: Even without a gallbladder to “grow” stones, crystals and stones can still form directly within the common bile duct (the main tube that carries bile to the intestine) [8][9]. These stones can block the flow of bile, causing pain and potentially leading to jaundice or pancreatitis [10][8].
  • Primary Biliary Dyskinesia: The bile ducts themselves may not move bile efficiently, leading to a backup of pressure [11].

The Ultrasound Trap: The “WES” Sign

Most patients are first suspected of having gallbladder issues after an ultrasound [12]. However, ultrasound can be surprisingly misleading when a gallbladder is missing.

Radiologists often look for the WES sign (Wall-Echo-Shadow) [12]. In a typical patient, this sign clearly shows a gallbladder wall, the “echo” of a stone, and a dark “shadow” behind it, which is considered definitive proof of gallstones [12].

In gallbladder agenesis, the ultrasound can produce a “False WES sign” [12]:

  • Bowel Gas or Tissue: Loops of the intestine can shift into the empty space where the gallbladder should be [12].
  • The Shadow: These nearby structures can create the same “shadowing” effect on the ultrasound screen as a stone-filled gallbladder [12].
  • The Misdiagnosis: This often leads doctors to erroneously believe they are looking at a contracted gallbladder (one that has shrunken around stones) or chronic cholecystitis (inflammation) [12][10].

Agenesis vs. Ectopic Gallbladder

It is also important to distinguish between agenesis (the organ never formed) and an ectopic gallbladder (the organ formed but is in the wrong place) [13]. An ectopic gallbladder might be hidden inside the liver (intrahepatic) or tucked behind other organs [14][15].

Confirming “isolated” agenesis means your care team has used advanced imaging, like an MRCP, to prove the gallbladder isn’t just “hiding” elsewhere [13]. If an ectopic gallbladder is found, it usually does not require surgical removal unless it is actively diseased (such as containing stones or being inflamed) [15].

Next Page: Confirming the Diagnosis: Imaging and Surgery

Common questions in this guide

Why do I have gallbladder pain if I was born without a gallbladder?
The pain usually stems from other parts of your biliary system. It can be caused by Sphincter of Oddi dysfunction, where a muscular valve doesn't open correctly, or from crystals and stones forming directly inside your common bile duct.
Why did my ultrasound show gallstones if my gallbladder is missing?
In patients with gallbladder agenesis, loops of the intestine can shift into the empty space where the organ should be. On an ultrasound, this tissue and gas can create a false shadow that looks exactly like a shrunken gallbladder filled with stones.
What is the difference between an ectopic gallbladder and gallbladder agenesis?
An ectopic gallbladder is one that formed during fetal development but ended up in the wrong place, such as inside the liver. Agenesis means the organ never formed at all, which doctors confirm using advanced imaging like an MRCP.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.If my gallbladder is missing, what exactly is causing the pressure and pain in my upper right abdomen?
  2. 2.Could my symptoms be caused by Sphincter of Oddi Dysfunction or stones in my remaining bile ducts?
  3. 3.How can we be absolutely certain this isn't an ectopic gallbladder located somewhere else, like inside my liver?
  4. 4.What specific findings on my previous ultrasound led to the initial misdiagnosis of gallstones?
  5. 5.Should I be managed by a general surgeon or a gastroenterologist now that we know my anatomy?

Questions For You

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References

References (15)
  1. 1

    A case of an absent gall bladder presenting as biliary colic in a tertiary care hospital in Karachi.

    Talib V, Khan AS, Dawani S, Ahmed H

    JPMA. The Journal of the Pakistan Medical Association 2019; (69(5)):731-733.

    PMID: 31105299
  2. 2

    Gallbladder agenesis: An accidental finding during laparotomy for hepatic tumor.

    Mohammed AA, Arif SH

    International journal of surgery case reports 2021; (82()):105875 doi:10.1016/j.ijscr.2021.105875.

    PMID: 33857765
  3. 3

    A case report of a patient with gallbladder agenesis resulting in a common bile duct injury.

    Bahraini A, Odom JW, Talukder A

    International journal of surgery case reports 2018; (51()):99-101 doi:10.1016/j.ijscr.2018.07.024.

    PMID: 30149331
  4. 4

    Gallbladder agenesis: A case report and review of the literature.

    Pipia I, Kenchadze G, Demetrashvili Z, et al.

    International journal of surgery case reports 2018; (53()):235-237 doi:10.1016/j.ijscr.2018.10.061.

    PMID: 30428439
  5. 5

    Gallbladder agenesis in the elderly: a diagnostic challenge.

    Ismail IB, Rebii S, Zenaidi H, Zoghlami A

    The Pan African medical journal 2020; (37()):259 doi:10.11604/pamj.2020.37.259.23268.

    PMID: 33598074
  6. 6

    Biliary Sphincter of Oddi Dysfunction.

    Haider A, Siddiqa A, Ali N, Mehershahi S

    Case reports in gastroenterology 2021; (15(1)):443-449 doi:10.1159/000514542.

    PMID: 34054398
  7. 7

    Osteoid Osteoma Masquerading as Cholelithiasis: A Case Report.

    Fox MA, Berger RJ, Wright KA, et al.

    JBJS case connector 2020; (10(1)):e0090 doi:10.2106/JBJS.CC.19.00090.

    PMID: 32044770
  8. 8

    CLINICAL AND EPIDEMIOLOGICAL EVALUATION OF COMPLICATIONS ASSOCIATED WITH GALLSTONES IN A TERTIARY HOSPITAL.

    Aguiar RGP, Souza Júnior FEA, Rocha Júnior JLG, et al.

    Arquivos de gastroenterologia 2022; (59(3)):352-357 doi:10.1590/S0004-2803.202203000-64.

    PMID: 36102431
  9. 9

    Concomitant Gallbladder Agenesis with Methimazole Embryopathy.

    Kato H, Mitani Y, Goda T, Yamaue H

    The American journal of case reports 2020; (21()):e926310 doi:10.12659/AJCR.926310.

    PMID: 32898128
  10. 10

    Gallbladder agenesis diagnosed during pregnancy- Case report and a literature review.

    Pinto MYP, Neelankavil S

    International journal of surgery case reports 2023; (105()):108019 doi:10.1016/j.ijscr.2023.108019.

    PMID: 36966713
  11. 11

    Clinical features and management of painless biliary type sphincter of Oddi dysfunction.

    Miyatani H, Mashima H, Sekine M, Matsumoto S

    The Journal of international medical research 2019; (47(7)):2940-2950 doi:10.1177/0300060519848628.

    PMID: 31122105
  12. 12

    Optimization of diagnostic ultrasonography of the gallbladder based on own experience and literature.

    Smereczyński A, Kołaczyk K, Bernatowicz E

    Journal of ultrasonography 2020; (20(80)):e29-e35 doi:10.15557/JoU.2020.0006.

    PMID: 32320550
  13. 13

    Case report of a gallbladder agenesis, a diagnostic challenge.

    Cegarra-Besora A, González-Álvarez P, Montraveta-Querol M, Bovo MV

    International journal of surgery case reports 2022; (94()):107026 doi:10.1016/j.ijscr.2022.107026.

    PMID: 35398782
  14. 14

    A Rare Case of a Left-sided Gallbladder Accompanied with an Aplastic Cystic Duct in a Patient with Acute Cholecystitis.

    Chatzifotiou D, Schnell M, Lupascu B, Gundlach M

    The American journal of case reports 2020; (21()):e920821 doi:10.12659/AJCR.920821.

    PMID: 32071285
  15. 15

    Complete mesocolic malposition of the gallbladder: An unusual case report with literature's review.

    Teke Z, Akcam AT

    Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES 2022; (28(4)):557-561 doi:10.14744/tjtes.2020.09274.

    PMID: 35485503

This page explains the symptoms and diagnostic challenges of gallbladder agenesis for informational purposes only. Always consult a gastroenterologist or surgeon to evaluate your abdominal pain and imaging results.

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