Treatment Success: A 66-Year-Old Woman Manages Acquired Gallbladder Agenesis with Conservative Therapy

A 66-year-old female patient with a 20-year history of chronic hepatitis B and a 5-year history of cholecystitis was diagnosed with acquired gallbladder agenesis after a prolonged period without medical follow-up. Despite being on entecavir therapy for hepatitis B, she had not adhered to her prescribed regimen and skipped medical evaluations for over a year. Upon visiting our clinic, a color ultrasound showed no visible gallbladder, and a subsequent CT scan revealed a severely shrunken gallbladder in the gallbladder fossa. The patient was diagnosed with acquired gallbladder agenesis and was treated with a combination of oral medications and dietary modifications. After six months of outpatient treatment, there was noticeable improvement—gallbladder atrophy had reduced, small amounts of bile were detected, and symptoms such as bloating had significantly improved.

Initial Consultation and Diagnosis

The patient, referred to as Auntie Zhang, had managed her chronic hepatitis B with intermittent use of entecavir and relied mainly on dietary restrictions to manage her health. She had been aware of her gallbladder issues for five years but only monitored them with biannual ultrasounds, during which a progressive reduction in gallbladder size was observed. Despite occasional bloating after meals, she experienced no severe discomfort and delayed medical evaluation for over a year. Upon ultrasound examination, no gallbladder was initially visible, prompting further investigation with an abdominal CT scan. The imaging revealed a shrunken gallbladder, confirming the diagnosis of acquired gallbladder agenesis.

Therapeutic Approach and Management Plan

Given the patient's progressive gallbladder atrophy and history of chronic inflammation, surgical removal was considered to prevent potential malignancy. However, the patient and her family opted for conservative treatment for six months, with surgery reserved as a last resort. A treatment regimen was initiated including anti-inflammatory and bile-stimulating medications—Cholic Acid Tablets and Ursodeoxycholic Acid Capsules—alongside liver-protective therapy with Compound Glycyrrhizin Tablets. The patient was advised to drink 1500–2000 ml of water daily, consume more fruits and vegetables, and avoid fatty and spicy foods to reduce gallbladder strain and support liver function.

Positive Outcomes After Six Months

After six months of consistent treatment and lifestyle adjustments, a follow-up ultrasound showed the presence of bile within the gallbladder, with measurements of 3.5cm × 1.8cm and slightly thickened walls. The patient reported reduced bloating, improved energy levels, and the ability to tolerate small amounts of fatty foods without discomfort. Liver function tests also showed improvement, and her spleen had returned to normal size. Encouraged by the results, the patient and her family were relieved to avoid surgery and committed to continuing the current treatment plan with regular monitoring.

Recommendations for Long-Term Management

While the patient has shown significant progress, it is crucial to remain vigilant. The gallbladder remains smaller than average, and the thickened walls indicate lingering inflammation. Continued dietary discipline is essential to avoid aggravating the condition. Patients are advised to:

1. Avoid high-fat and difficult-to-digest foods such as red meat, pastries, organ meats, and barbecued dishes.
2. Maintain hydration with water instead of sugary drinks or dairy, and practice portion control with frequent, smaller meals.
3. Schedule regular medical check-ups including ultrasounds, liver function tests, and complete blood counts to monitor gallbladder and liver health.

Conclusion and Preventive Insights

This case highlights the importance of early detection and consistent management of chronic gallbladder conditions. Acquired gallbladder atrophy, often linked to long-term inflammation, can be mitigated with lifestyle changes and medical support. Both older adults and younger individuals—especially those with irregular eating habits or poor dietary choices—are at risk. Maintaining regular meals, a balanced diet, and avoiding long-term consumption of stimulants like alcohol, coffee, and high-fat foods are essential for gallbladder and liver health. Timely medical intervention can make a significant difference in preventing severe complications, including the need for surgery or the risk of cancer.