Double gallbladder—intraoperative finding at laparoscopic cholecystectomy: Literature review

Duplication of the gallbladder is a rare entity. It is often appreciated at surgery and has a higher propensity for complications and conversion to open surgery. We report a case of laparoscopic recognition and removal of a duplicated gallbladder opening into the bile duct through separate cystic ducts, in a young male presenting with biliary colics. Both cystic ducts were clipped and divided, and cholecystectomy completed laparoscopically. Although uncommon, awareness of this anomaly may contribute to minimising iatrogenic bile duct injuries.

Bilobed gallbladder: a rare congenital anomaly of the biliary system

Duplication of the gallbladder is a rare congenital anomaly, which Boyden first illustrated in 1926. No additional risk of cholelithiasis or malignancy with this congenital anomaly was documented. However, this congenital anomaly is associated with more risk for complications during and after laparoscopic cholecystectomy. So, preoperative diagnosis is essential in identifying anatomical abnormalities to avoid biliary injuries at the time of surgery or the performance of an incomplete operation. The removal of an asymptomatic double gallbladder remains controversial. Here, we are reporting a case of the incidentally detected duplex gallbladder in a teenager and review the literature that will enrich the reader’s knowledge regarding this rare congenital anomaly.

A rare case of double gall bladder: a case report and review of literature

Double gall bladder is a rare congenital anomaly of the Hepatobiliary system with an incidence of 1:4000 due to abnormalities resulting during the embryogenesis during fourth to sixth week of gestation. Boyden was first to describe the duplication of the gallbladder and Harlaftis classification describes three types for the duplication of the gallbladder. Preoperative diagnosis of the duplication of the gallbladder has to be confirmed to minimise the complications during the surgery and post operatively. Sometimes the duplication of the gallbladder is missed preoperatively and hence increasing the risk and complications during the cholecystectomy. MRCP is the investigation of choice for preoperative diagnosis of the duplication and the laparoscopic cholecystectomy being the treatment of choice for the double gallbladder. We encountered a 25 year old girl with duplicate gallbladder who underwent laparoscopic cholecystectomy with removal of both gallbladders successfully.

Gallbladder Duplication - A Rare Congenital Anomaly

Gallbladder duplication is a rare congenital malformation, occurring in about one per 3000 - 4000 births.1 Presence of a double gallbladder was first reported in 31 BC by Pliny.2 Since then, 213 cases of true duplication of gallbladder have been described. Anatomic variation of duplication of gallbladder is classified according to Boyden’s classification¹ into two groups – 1) Vesica fella divisa and 2) Vesica fella duplex (again divided into Y type and H type).

Laparoscopic management of rare “ H type” duplication of gall bladder

A duplicated gallbladder is a rare congenital anomaly with an incidence of 1:4000 live births. Theycan remain asymptomatic and identified incidentally or present as acute cholecystitis, empyema,torsion, cholecystoenteric fistula, Gall bladder lump, or carcinoma. Here the current case is aboutdiscussing a case of a 25-year-old female who presented with symptomatic gallstone disease with aduplicated gallbladder having multiple stones in both the gallbladders. MRCP performedpreoperatively revealed Y type duplication (double Gall bladder with common cystic duct).Laparoscopic cholecystectomy was performed and it finally revealed H type duplication (double Gallbladder with separate cystic ducts for each Gall Bladder).

Incidental intraoperative finding of gallbladder duplication in a patient with a choledochal cyst

Here, we report a case of coexistence of a duplicate gallbladder and choledochal cyst, which was overlooked preoperatively and confirmed via intraoperative inspection and pathological examination. We concluded that a high index of suspicion is required to diagnose a double gallbladder, and special attention should be paid to preoperative radiological imaging when treating patients with choledochal cysts because these patients present a higher incidence of biliary anomalies.