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Cheng Y, Xi Z, Zhuang A, Li X, Wang Y, Yan G, Zhang G, Zhang C, Chen K, Huang YY, Zhou C, Wang Q, Li W. A case of H-type double gallbladder anomaly: A case report. Medicine (Baltimore) 2024; 103:e39284. [PMID: 39213215 PMCID: PMC11365664 DOI: 10.1097/md.0000000000039284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 07/11/2024] [Accepted: 07/23/2024] [Indexed: 09/04/2024] Open
Abstract
RATIONALE Biliary system anomalies, such as duplicated gallbladders, are rare congenital conditions that present significant diagnostic challenges. Dr. Boyden's classification system, especially the H-type anomaly, offers vital insight into these variations. Failure to detect these anomalies preoperatively can increase the risk of surgical complications, making early identification crucial for surgical planning. PATIENT CONCERN A 42-year-old male, asymptomatic, was incidentally found to have a gallbladder mass during routine imaging. An upper abdominal magnetic resonance imaging showed gallbladder wall thickening, gallstones, and a liver lesion. Despite the absence of symptoms, a laparoscopic cholecystectomy revealed an atrophied gallbladder with a cystic duct cyst, which was identified as an H-type double gallbladder anomaly. The surgery was completed without complications, and pathology confirmed the presence of gallstones and inflammation. DIAGNOSES The patient was diagnosed with a duplicated gallbladder, classified as an H-type anomaly, following laparoscopic cholecystectomy. Preoperative imaging identified gallbladder wall thickening and gallstones, and further investigation during surgery confirmed the congenital anomaly. INTERVENTIONS The patient underwent laparoscopic cholecystectomy for the removal of the gallbladder, and during the procedure, an H-type double gallbladder anomaly was discovered. The surgery proceeded without incident, ensuring the complete excision of the gallbladders. OUTCOMES The case highlights the diagnostic difficulty of identifying duplicated gallbladders and the importance of advanced imaging techniques in detecting atypical anatomical variations. The successful laparoscopic removal of both gallbladders illustrates the current capabilities of minimally invasive surgery. Postoperative recovery was uneventful, and the pathology confirmed gallstones and inflammation. LESSONS This case emphasizes the importance of recognizing biliary anomalies such as duplicated gallbladders to avoid complications during surgery. Preoperative identification, aided by imaging, and careful surgical planning are key to managing these rare conditions. The case contributes to the growing body of knowledge about biliary system anomalies and reinforces the need for comprehensive management strategies to ensure optimal patient outcomes.
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Affiliation(s)
- Yingxue Cheng
- Cancer Research Center, School of Medicine, Xiamen University, Xiamen, Fujian, PR China
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, Fujian, PR China
| | - Zhe Xi
- Cancer Research Center, School of Medicine, Xiamen University, Xiamen, Fujian, PR China
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, Fujian, PR China
| | - Aobo Zhuang
- Cancer Research Center, School of Medicine, Xiamen University, Xiamen, Fujian, PR China
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, Fujian, PR China
| | - Xi Li
- Department of Biostatistics, School of Public Health, Harvard University, Cambridge, MA
| | - Yue Wang
- Cancer Research Center, School of Medicine, Xiamen University, Xiamen, Fujian, PR China
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, Fujian, PR China
| | - Guangting Yan
- Cancer Research Center, School of Medicine, Xiamen University, Xiamen, Fujian, PR China
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, Fujian, PR China
| | - Geng Zhang
- Cancer Research Center, School of Medicine, Xiamen University, Xiamen, Fujian, PR China
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, Fujian, PR China
| | - Chenhe Zhang
- Cancer Research Center, School of Medicine, Xiamen University, Xiamen, Fujian, PR China
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, Fujian, PR China
| | - Kun Chen
- Cancer Research Center, School of Medicine, Xiamen University, Xiamen, Fujian, PR China
- Department of Hepatobiliary Surgery, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, PR China
| | - Yang Yang Huang
- Cancer Research Center, School of Medicine, Xiamen University, Xiamen, Fujian, PR China
- Department of Hepatobiliary Surgery, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, PR China
| | - Changsheng Zhou
- Cancer Research Center, School of Medicine, Xiamen University, Xiamen, Fujian, PR China
- Department of Hepatobiliary Surgery, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, PR China
| | - Qing Wang
- Cancer Research Center, School of Medicine, Xiamen University, Xiamen, Fujian, PR China
- Department of Hepatobiliary Surgery, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, PR China
| | - Wengang Li
- Cancer Research Center, School of Medicine, Xiamen University, Xiamen, Fujian, PR China
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, Fujian, PR China
- Department of Hepatobiliary Surgery, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, PR China
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Tayayouth S, Kalerum P, Girddee J, Pattanapon N, Yodsheewan R, Danpanang N, Theerapan W, Assawarachan SN. Double cholecystectomy of duplex gallbladder associated with chronic cholecystitis in a cat. Vet Med Sci 2024; 10:e1337. [PMID: 38124456 PMCID: PMC10766050 DOI: 10.1002/vms3.1337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/15/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023] Open
Abstract
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.
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Affiliation(s)
- Sirada Tayayouth
- Kasetsart University Veterinary Teaching Hospital Kamphaeng SaenFaculty of Veterinary MedicineKasetsart UniversityKamphaeng Saen, Nakhon PathomThailand
| | - Patimaporn Kalerum
- Kasetsart University Veterinary Teaching Hospital Kamphaeng SaenFaculty of Veterinary MedicineKasetsart UniversityKamphaeng Saen, Nakhon PathomThailand
| | - Jirayu Girddee
- Kasetsart University Veterinary Teaching Hospital Kamphaeng SaenFaculty of Veterinary MedicineKasetsart UniversityKamphaeng Saen, Nakhon PathomThailand
| | - Nakrob Pattanapon
- Kasetsart University Veterinary Teaching Hospital Kamphaeng SaenFaculty of Veterinary MedicineKasetsart UniversityKamphaeng Saen, Nakhon PathomThailand
| | - Rungrueang Yodsheewan
- Department of PathologyFaculty of Veterinary MedicineKasetsart UniversityBangkokThailand
| | - Nut Danpanang
- Kasetsart University Veterinary Teaching Hospital Hua HinFaculty of Veterinary MedicineKasetsart UniversityHua Hin, Prachuap Khiri KhanThailand
| | - Wutthiwong Theerapan
- Department of Companion Animal Clinical SciencesFaculty of Veterinary MedicineKasetsart UniversityBangkokThailand
| | - Sathidpak Nantasanti Assawarachan
- Department of Companion Animal Clinical SciencesFaculty of Veterinary MedicineKasetsart UniversityBangkokThailand
- Endocrinology and Gastroenterology UnitKasetsart University Veterinary Teaching HospitalFaculty of Veterinary MedicineKasetsart UniversityBangkokThailand
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Spain HN, Penninck DG, Thelen M. Ultrasonographic prevalence and proposed morphologic classification of bilobed gallbladder in cats. J Feline Med Surg 2022; 24:986-993. [PMID: 34709081 PMCID: PMC10812300 DOI: 10.1177/1098612x211055629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Heather N Spain
- Department of Radiology, BluePearl, The Pet Specialists of Monterey, Del Rey Oaks, CA, USA
| | - Dominique G Penninck
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, USA
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Jouni SO, Ahmad SM, Wardeh AM, Issa AM, Alloush AM. Symptomatic H- type gallbladder in a male patient: A rare case report from Syria. Ann Med Surg (Lond) 2022; 78:103885. [PMID: 35734664 PMCID: PMC9207078 DOI: 10.1016/j.amsu.2022.103885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/24/2022] [Accepted: 05/29/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction and importance Case presentation Clinical discussion Conclusion The presence or absence of sickness in accessory gallbladder depends on the presence or absence of complications which are caused by the same Pathogenic factors that are indicted in complicated mono gall bladder. As ultrasounds can be limited in distinguishing bilobed gallbladder and real duplication, a following MRI should be performed for better investigating and evaluation. In accidental cases, both gallbladders should be considered if the surgical approach was approved. In H-type double gallbladder intervention there is a high potential to damage the biliary ducts and arteria hepatica.
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Affiliation(s)
- Sarah Omar Jouni
- Faculty of Medicine, Tishreen University, Latakia, Syria
- Corresponding author. Faculty of Medicine, Cancer Research Center, Tishreen University, Lattakia, Syria.
| | | | | | | | - Ali Muhammad Alloush
- Department of General Surgery, Faculty of Medicine, Tishreen University, Lattakia, Syria
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Gadour E, Hassan Z, Hassan A. Y-Shaped Vesica Fellea Duplex Gallbladder Causing Acute Biliary Pancreatitis. Cureus 2021; 13:e14676. [PMID: 33912366 PMCID: PMC8071095 DOI: 10.7759/cureus.14676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2021] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Eyad Gadour
- Gastroenterology and Hepatology, University Hospitals of Morecambe Bay National Health Service Foundation Trust, Lancaster, GBR
| | - Zeinab Hassan
- Faculty of Medicine, The National Ribat University, Khartoum, SDN
| | - Abdalla Hassan
- Gastroenterology and Hepatology, University Hospitals of Morecambe Bay National Health Service Foundation Trust, Lancaster, GBR
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Alsharedah AH, Alotaibi SM, Khan BF, Alshaibani AK, Algarni SA. Laparoscopic Management of Gallbladder Duplication: A Case Report. Cureus 2020; 12:e10675. [PMID: 33133841 PMCID: PMC7592526 DOI: 10.7759/cureus.10675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- Ali H Alsharedah
- Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Sarah M Alotaibi
- Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Basim F Khan
- Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Askar K Alshaibani
- Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Saad A Algarni
- Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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Goh YM, Goh YL, Ewan LC, Turner PD, Lapsia S, Subar DA. A case report of duplex gallbladder and review of the literature. Int J Surg Case Rep 2015; 14:179-81. [PMID: 26282559 PMCID: PMC4573605 DOI: 10.1016/j.ijscr.2015.07.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/22/2015] [Accepted: 07/23/2015] [Indexed: 01/21/2023] Open
Abstract
What is already known on this topic? Duplex gallbladder is a rare congenital abnormality.
What this study adds? The importance of thorough investigation to avoid missed diagnosis. Surgery is only indicated for symptomatic duplex gallbladders.
Gallbladder duplication is a rare congenital abnormality first described by Boyden in 1926. Pre-operative diagnosis is essential in identifying anatomical abnormalities in order to avoid biliary injuries at the time of surgery or performance of an incomplete operation. We present a case of a duplex gallbladder and review of the literature.
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Affiliation(s)
- Y M Goh
- Department of Hepato-Biliary Surgery, East Lancashire Teaching Hospitals NHS Trust, United Kingdom
| | - Y L Goh
- Department of Hepato-Biliary Surgery, East Lancashire Teaching Hospitals NHS Trust, United Kingdom
| | - L C Ewan
- Department of Hepato-Biliary Surgery, East Lancashire Teaching Hospitals NHS Trust, United Kingdom
| | - P D Turner
- Department of Upper Gastro-Intestinal Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, United Kingdom
| | - S Lapsia
- Department of Radiology, East Lancashire Teaching Hospitals, NHS Trust, United Kingdom
| | - D A Subar
- Department of Hepato-Biliary Surgery, East Lancashire Teaching Hospitals NHS Trust, United Kingdom.
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