Gallbladder Duplication - A Rare Anomaly Detected

Gall Bladder Duplication

A Rare Anomaly Detected on Preoperative Imaging

Hellenic Journal of Surgery on 27 October 2015

Abstract

Congenital anomalies are frequently encountered in surgery. They pose a dilemma in surgical decision-making and if undetected, they may lead to surgical complications. Gallbladder duplication is a rare anomaly with an incidence of 1 in 3000-4000. Preoperative imaging is often the only modality of diagnosis, as there are no specific symptoms for the pathology. Preoperative diagnosis and appreciation and of this anomaly is especially important to prevent possible surgical complications.

Case History

A 36-year-old man presented at a rural medical college with a 6-month history of intermittent vague upper abdominal pain. There were no other associated symptoms. Examination was unremarkable. Abdominal ultrasonography revealed two gallbladders, one of which contained calculi. Since it was difficult to distinguish between a bilobed gallbladder and true gallbladder duplication, a CECT scan was performed which confirmed the presence of gallbladder duplication. MRCP would have been more useful, but the facility was not available at the specific hospital. At surgery, a double gallbladder with a single cystic duct was identified. One of the gallbladders was chronically inflamed and contained multiple gallstones, whereas the other was normal.

USG showing duplication of the gallbladder

CECT scan showing duplication of the gallbladder

Discussion

Gallbladder duplication is a rare congenital anomaly with an incidence of 1 in 3000-4000. According to Boyden’s classification, it can be classified into two main types:
(i) Vesica fellea divisa (bilobed or bifid gallbladder)
(ii) Vesica fellea duplex (double gallbladder with two cystic ducts), which may be Y-shaped (united before entering the common bile duct) or H-shaped (two cystic ducts entering separately into the biliary tree).

It is important that the condition be diagnosed preoperatively as the second gallbladder may either be overlooked during surgery or pose an increased risk of injury to the biliary tree. Ultrasonography is the preferred first line of imaging. However, several other pathologies may mimic a duplicate gallbladder on ultrasonography viz. folded gallbladder, choledochal cyst, phrygian cap, pericholecystic fluid, gallbladder diverticulum, vascular band across the gallbladder and focal adenomyomatosis.
MRCP is the subsequent investigation of choice, not only to rule out the above, but more importantly to evaluate the biliary tree, particularly the cystic duct. CECT is also a simple but useful modality of investigation. Laparoscopic

Boyden’s Classification

Dr. Susenjit Prasad Mahato, one of the best gallbladder surgeon in kolkata, has operated many critical gallbladder surgeries successfully with his great experience and efficiency. This rare case was one of his biggest challenge which also had been operated successfully.