A case report of duplex gallbladder and review of the literature

'H-type' duplex gallbladder resected laparoscopically with transcystic choledochoscopy and stone retrieval

A duplex gallbladder is an extremely rare congenital anomaly that while may remain asymptomatic, may also develop into biliary colic, cholecystitis, cholangitis or pancreatitis. In these circumstances, it is advisable to surgically remove both gallbladders. Typically, a cholecystectomy is performed laparoscopically as this aids patient recovery and complication risk; however, when congenital abnormalities are present, some may choose to revert to an open operation. Through this case, we demonstrate that even when presented with a duplex gallbladder during surgery, it is safe to remove it laparoscopically as well as performing transcystic choledochoscopy and basket retrieval without complications.

Confronting the uncommon: Cholecystitis and cholangitis in a young adult arising from a bilobed gallbladder with subvesicle duct - A case report and review of literature

INTRODUCTION AND IMPORTANCE

Bilobed gallbladder is a rare congenital anomaly characterized by the duplication of the gallbladder. It presents a unique challenge for surgeons due to its infrequency and the potential for perioperative complications. Anatomical variations, including the presence of the subvesicle duct of Luschka, should be suspected in these cases.

CASE PRESENTATION

In our case report, we present the clinical details of a **23-year-old male** who presented with symptoms of acute cholecystitis and cholangitis. Preoperative imaging revealed a bilobed gallbladder, and incidentally, intraoperative evidence of the subvesicle duct/duct of Luschka was also observed during a successful laparoscopic cholecystectomy. Importantly, the patient experienced no postoperative complications.

CLINICAL DISCUSSION

This case highlights considering bilobed gallbladder as a differential diagnosis in patients with cholecystitis or cholangitis is crucial. Surgeons should be vigilant about this anomaly when evaluating patients with gallbladder-related symptoms.

CONCLUSION

We understand precise imaging plays a pivotal role in guiding surgical planning. Detecting bilobed gallbladder preoperatively allows for better assessment of biliary structures and helps prevent bile leaks during surgery. Although rare, awareness of bilobed gallbladder and its associated anatomical variants is essential for optimal patient management and successful surgical outcomes. Surgeons should remain attentive to such anomalies to ensure safe and effective procedures.

Double cholecystectomy of duplex gallbladder associated with chronic cholecystitis in a cat

A 6-year-old female neutered Persian cat presented with hyporexia and gradual weight loss over 6 months. Physical examination revealed cranial abdominal pain. Haematology and serum biochemistry were within normal limits. Abdominal ultrasonography and a computed tomography scan suggested a non-neoplastic mass compressing the gallbladder. During an exploratory laparotomy, a duplex gallbladder with two separate cystic ducts was diagnosed intraoperatively. The mass identified using the imaging techniques was an abnormal right gallbladder which was distended with immobile mucoid bile and a thickened wall. The left gallbladder and cystic duct were grossly normal. A cholecystectomy of both gallbladders was performed. Histopathology of the right gallbladder identified chronic cholecystitis. The cat made a good recovery from surgery and reported complete resolution of its hyporexia and a return to normal body weight. This is the first report of a successful cholecystectomy of a duplex gallbladder with chronic cholecystitis of a single gallbladder.

Ultrasonographic prevalence and proposed morphologic classification of bilobed gallbladder in cats

OBJECTIVES

Morphologic anomalies of the feline gallbladder (GB) have been previously reported in the literature. These morphologic variants are frequently encountered on routine abdominal ultrasound examination. The aim of this study was to provide an ultrasonographic classification system of these variants and document the overall incidence in the feline population.

METHODS

A prospective, descriptive study was undertaken; cats that had an abdominal ultrasound examination that included at least one sagittal and transverse plane image of the GB were included. GB shape was evaluated and categorized based on a classification scheme of morphologic variants modified from the human literature. Septated (S), bilobed (B1, B2, B3), duplex (D) and complex (C) categories were described.

RESULTS

Of 516 cats included in the study, 389 had normal GB morphology, while 127 had anomalous GB morphology. The overall incidence rate of anomalous GB morphology was 24.61%. When examined by morphologic type, the septated (S) morphology had an incidence of 9.69%. A bilobed (B) morphology was the most commonly observed classification; incidence was 14.35% within our population; incidence of B1, B2 and B3 subtypes were 2.91%, 6.98% and 4.46%, respectively. Duplex GBs only made up 0.39% of the total population. The incidence of complex (C) morphologies was 0.19%.

CONCLUSIONS AND RELEVANCE

The incidence of GB morphologic anomalies was higher in our population than previously reported. Identification of these anomalies on routine ultrasound evaluation is common; numerous different morphologies can be identified and a standardized classification scheme is proposed. Complete evaluation of morphology can be challenging, particularly with regard to cystic duct anatomy. Clinical significance is uncertain and future studies are warranted to determine the relationship between morphologic variants and hepatobiliary disease.

Y-Shaped Vesica Fellea Duplex Gallbladder Causing Acute Biliary Pancreatitis

Gallbladder duplication refers to the splitting of "gallbladder primordium" during the early embryonic development in the fifth or early sixth week. Although it is a very rare congenital abnormality and most of the patients will be asymptomatic, yet the symptomatic cases present with abdominal complaints like nausea vomiting, abdominal pain leads to cholecystitis, cholangitis, biliary colic, or pancreatitis. Herein, we present a case report of duplication of the gallbladder, which was difficult to diagnose on radiology. We report a case of a 35-year-old female who was admitted with acute gallstone pancreatitis. The diagnosis was made by magnetic resonance cholangiopancreatography (MRCP) and blood tests. She underwent an inpatient endoscopic retrograde cholangiopancreatography (ERCP) which cleared the bile duct and confirmed the diagnosis of the duplex gallbladder. The patient was then discharged home and an outpatient cholecystectomy is being planned.The duplex gallbladder may possibly be associated with other anomalies of the bile duct system. Biliary pancreatitis has been associated with such abnormality. Accurate diagnosis is crucial to achieving due to the possibility that gallbladder can be missed in imaging testing. Cholecystectomy required extreme care because these anomalies can lead to critical injuries of the bile duct and vascular system.

Duplication of the Gallbladder as an Operative Surprise: A Case Report with Review of the Literature

Introduction

Duplication of the gallbladder is a rare congenital anomaly of the biliary system. Anomalous anatomy of the biliary system is associated with an increased risk of complications such as bile duct injury during cholecystectomy. Herein, I present a case report of duplication of the gallbladder, which was an operative surprise as the patient's preoperative workup did not reveal any evidence of duplication of the gallbladder. Case Report. A 60-year-old female was admitted for management of recurrent pancreatitis. Diagnosis of biliary pancreatitis was made as her CT and US revealed cholelithiasis. During laparoscopic cholecystectomy, she was found to have duplication of the gallbladder, which was a surgical surprise. Both the gallbladders were successfully removed, and the patient had an uneventful postoperative course.

Conclusion

Duplication of the gallbladder is a rare congenital anomaly, which could be associated with other congenital anomalies of the bile duct and vascular system. Extreme care should be taken during cholecystectomy as these anomalies could lead to serious injury to the bile duct and vessels.

Laparoscopic Management of Gallbladder Duplication: A Case Report

Laparoscopic cholecystectomy has become one of the most commonly performed abdominal surgeries worldwide. Several anatomic variations and congenital malformations in the gallbladder and biliary anatomy have been described. We reported the case of a middle-aged woman who presented with jaundice and abdominal pain. Her laboratory investigations revealed an elevated bilirubin level (mainly the direct component). The patient showed an improvement in the clinical and laboratory parameters after conservative management. Then, the patient was prepared for a laparoscopic cholecystectomy which revealed a duplication of the gallbladder with two distinct cystic ducts draining independently to the common bile duct. The procedure was completed uneventfully. This type of gallbladder duplication is among the least common types. The case highlights the importance of having a meticulous intraoperative evaluation of the biliary anatomy to avoid potential complications and injuries.

Cholecystitis on gallbladder duplication: A case report and literature review

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Anatomical variants of biliary tree considered as the most important predisposing for iatrogenic bile duct injuries during cholecystectomy.

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Knowledge of variant gallbladders is of an extreme surgical importance in the areas of operating abdomen procedure.

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Especially this variant can be associated with vessels variations.

Introduction

Gallbladder Duplication is an uncommon anomaly of the biliary system that rarely seen during the routine ultrasound examination. It is a challenge that can be encountered by surgeons and associated with an increased risk of complications after cholecystectomy.

Case presentation

We report the case of a 58-year-old woman, presented to the emergency department with persistent right upper quadrant pain. Ultrasound exam detected Gallbladder Duplication with lithiasic cholecystitis in both of them. Besides, a Computed Tomography and a Magnetic Resonance Imaging confirmed the diagnosis showing a hepatic abscess by contiguity. The Patient was operated and, three days later, she was discharged home without incident.

Discussion

Gallbladder duplication is an anatomic biliary variant, which can associate with biliary ducts malformation. It can complicate the diagnosis and the surgical management of symptomatic Cholelithiasis or Cholecystitis. So, defining the exact anatomy of the biliary tree before surgery is crucial. Currently, the imaging technique, widely used for evaluating of the biliary tree, is the Magnetic Resonance Cholangiography. Laparoscopic cholecystectomy is the treatment of choice.

Conclusions

Duplication of the gallbladder that could now be detected preoperatively by imaging should always be in a surgeon’s mind, since it has been associated with anatomical biliary and vessels variations.

Duplicate gallbladder: A case report of a patient with cholecystitis after cholecystectomy

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Cholecystitis after cholecystectomy raises suspicions for duplicate gallbladder.

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Imaging techniques demonstrating biliary anatomy can diagnose duplicate gallbladder.

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Duplicate gallbladders arise from either a common or duplicate primordium.

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Gallbladder disease is sufficient indication for resection of duplicate gallbladder.

Introduction

Duplicate gallbladder is a congenital anomaly with various anatomical presentations that can pose difficult diagnostic dilemmas. This case presents the consequence of recurrent cholecystitis after prior cholecystectomy due to delay in diagnosis of a duplicate gallbladder and insufficient treatment at first presentation. It also provides the opportunity to discuss the anatomical variations of duplicate gallbladders and their clinical implications.

Presentation of case

We report on a 46-year-old woman who presented with symptoms of cholecystitis despite a history of cholecystectomy. Magnetic resonance cholangiopancreatography (MRCP) as well as review of intraoperative cholangiogram from the index surgery identified a cystic structure continuous with the biliary tree. Laparoscopic cholecystectomy was performed and histology confirmed a duplicate gallbladder. The patient did well post-operatively without any complications.

Discussion

Harlaftis’s classification of duplicate gallbladder categorizes anatomical variations based on embryological origin. Though rarity contributes to missed diagnosis, modern imaging techniques that delineate the biliary tree can identify these abnormalities. Recognizing these variations can identify risk for recurrent disease preoperatively and thereby guide surgical decision-making.

Conclusion

Duplicate gallbladder poses a risk for the unique presentation of recurrent cholecystitis despite cholecystectomy. Advanced imaging techniques that demonstrate biliary anatomy can identify duplicate gallbladder perioperatively. For those presenting with disease in any one gallbladder, resection of both is ideal to prevent recurrence of disease.

Gallbladder duplication and cholecystitis

Cholecystitis is a common gallbladder pathology characterized by abdominal pain, positive Murphy sign and elevated white blood count. Abdominal ultrasound usually gives a definite diagnosis. Duplication of the gallbladder is a rare congenital anomaly that can either be asymptomatic or and can present with symptoms associated with cholelithiasis, cholecystitis, cholangitis or pancreatitis. Clinically indistinguishable from regular gallbladder pathologies. The management of duplicated gallbladder is similar to that of other gallbladder diseases, if one or both gallbladders cause symptoms, cholecystectomy should be done for both gallbladders. We present a case of a 50-year-old female patient, she presented to the emergency room with abdominal pain and tenderness. Ultrasound detected a gallbladder duplication with cholecystitis in one of them and magnetic resonance cholangiopancreatography confirmed this diagnosis. Surgery was decided and the patient underwent full recovery. Y-shaped gallbladder duplication with cholecystitis due to cholelithiasis in one of them was the final diagnosis.

Bilobed gallbladder: a rare congenital anomaly

Bilobed gallbladder is a rare form of duplication of gallbladder. Preoperative diagnosis is important to avoid peroperative complications; however, it is also a challenge as imaging reports are often confounding. A case of bilobed gallbladder managed successfully laparoscopically is presented.

Prenatal and accurate perinatal diagnosis of type 2 H or ductular duplicate gallbladder

Background

Double gallbladder is a rare biliary anomaly. Perinatal diagnosis of the disorder has been reported in only 6 cases, and in 5 of them the diagnosis was based on ultrasound imaging only. However, the ultrasound technique alone does not provide a sufficiently precise description of cystic ducts and biliary anatomy, an information that is crucial for a correct classification and for a possible future surgery.

Case presentation

At 21 weeks of gestational age of an uneventful pregnancy in a 38 year old primipara mother, a routine ultrasound screening detected a biliary anomaly in the fetus suggestive of a double gallbladder. A neonatal abdominal ultrasonography performed on postnatal day 2 confirmed the diagnosis. On day 12 the newborn underwent a Magnetic Resonance Cholangiopancreatography (MRCP) that clearly characterized the anatomy of the anomaly: both gallbladders had their own cystic duct and both had a separate insertion in the main biliary duct.

Conclusions

We report a case of early prenatal suspected duplicate gallbladder that was confirmed by a neonatal precise diagnosis of a Type 2, H or ductular duplicate gallbladder, using for the first time 3D images of Magnetic resonance cholangiopancreatography in a newborn. An accurate anatomical diagnosis is mandatory in patients undergoing a possible future cholecystectomy, to avoid surgical complications or reoperations. Therefore, in case of a perinatal suspicion of a double gallbladder, neonates should undergo a Magnetic resonance cholangiopancreatography.

A review of the Literature about this variant is included.

Electronic supplementary material

The online version of this article (10.1186/s12887-018-1043-9) contains supplementary material, which is available to authorized users.

Pediatric cholangiopathies: diseases of the gallbladder and biliary tract

Pediatric gallbladder and bile duct disease encompasses a broad spectrum of processes, from congenital to developmental to neoplastic. We describe normal pediatric biliary anatomy and summarize the most common pathologic entities, with a focus on non-invasive imaging techniques and findings. Ultrasound is the first-line imaging modality in children with suspected biliary pathology based on its widespread availability, cost effectiveness, and lack of ionizing radiation. MRI and MRCP are often used for further evaluation in cases of diagnostic uncertainty and for surgical planning.