Gallbladder duplication as an incidental finding: a rare anatomic variant.

Resumen La duplicidad de la vesícula biliar es una malformación congénita poco frecuente que puede presentarse de tres formas diferentes en función de la morfología de la propia vesícula y de la vía biliar. La sintomatología que suele provocar es superponible a los casos de vesícula biliar única, siendo la mayor parte de los casos asintomáticos. Es importante realizar un correcto diagnóstico mediante pruebas de imagen para que, en el caso de que tenga que intervenirse quirúrgicamente, orientar al cirujano de forma precisa.

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).

Hepatic hilum-type II choledochal cyst masquerading as gallbladder duplication

Choledochal cyst and gallbladder duplication are rare congenital anomalies. They typically are surgical problems of infancy or childhood but rarely may present in adults also. Despite high resolution imaging, the differentiation of type II choledochal cyst from gallbladder duplication often causes the diagnostic dilemma; which may result in high risk for intraoperative iatrogenic injury. Operative management of choledochal cyst is the definite treatment because of its malignant potential. A type II choledochal cyst arising from the hepatic hilum presenting as gallbladder duplication on imaging has not been reported earlier in the literature and here we present a case report of the same which was managed successfully.

Laparoscopic Double Cholecystectomy in a Pediatric Patient for Gallbladder Duplication

Gall bladder duplication is a rare congenital anomaly that can be identified clinically during the workup for gall bladder-related symptoms. This anatomic variation can complicate surgery, and yet there are few published reports of this variant causing symptoms in pediatric patients. This is a case of a 17-year-old female with a history of Arnold–Chiari malformation type I, presenting with right upper quadrant pain. Outside computed tomography reported a trilobed gall bladder, while magnetic resonance cholangiopancreatography demonstrated a duplicated gall bladder. Endoscopic resonance cholangiopancreatography (ERCP) showed a rare anatomic variant of duplicated gall bladder with an accessory right hepatic duct branching off the cystic duct. Due to complex anatomy, both indocyanine green and intraoperative cholangiogram (IOC) were utilized for a successful laparoscopic cholecystectomy. Only ERCP and IOC were able to clearly identify the aberrant right hepatic duct. Final pathology confirmed acute and chronic cholecystitis without dysplasia or cholelithiasis. This case highlights a rare anomaly of an aberrant right hepatic duct in the setting of gallbladder duplication in a pediatric patient. We would recommend both ERCP and IOC during the laparoscopic surgical approach as they were the only imaging modalities to identify the patient’s correct anatomy, likely due to the size of pediatric biliary structures.

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.