Gallbladder duplication can be difficult to diagnose and identify, which can be a clinical issue. Since it can complicate a simple hepatobiliary surgery or a gallbladder condition, it is crucial to recognize this aberration and its many kinds. A 46-yearold lady who was admitted as a case of cholelithiasis and underwent effective surgical therapy of symptomatic gallbladder duplication is the subject of this case report. Our case report highlights various crucial points. Preoperative diagnosis is crucial in the event of surgery to avoid potential biliary injuries or reoperation in the event that the accessory gallbladder was missed during initial surgery. Laparoscopic cholecystectomy is still an option for safe intervention, although caution is still advised to prevent complications or the need for additional surgeries.
It is uncommon for the biliary system to duplicate, and one in 4,000 to 5,000 people are estimated to have double gallbladder. There are different anatomic variations of a double gallbladder. Hence, it is crucial for a surgeon to be aware of them, in order to understand and proceed with a treatment plan. Lack of knowledge regarding the variants of gallbladder can prolong and complicate the surgery.
A 46-year-old woman presented to the General Surgery Clinic complaining of right upper quadrant pain for more than 6 months, worsening recently. Increasing after consuming fatty meals, not associated with fever. Physical examination findings were consistent with the likelihood of cholelithiasis. Lab-wise there was no leucocytosis in the CBC, LFTs were all within the normal range. An ultrasound image was done which showed gallstone measuring 1.5cm in size near the neck, with no wall thickening or pericholecystic fluid or signs of cholecystitis (Figure 1). A CT scan was done and it showed gallbladder distension with mild intrahepatic and extrahepatic biliary duct dilation, no CBD stones (Figure 2). Neither of the imaging showed any variation of the biliary system. She was admitted electively for laparoscopic cholecystectomy. Intraoperatively, a double gallbladder was identified and completely excised, along with common bile duct dilation. The rest of the operation was proceeded successfully. A bi-lobed gallbladder, double gallbladder with a common neck (Boyden type Vesica fellea divisa) was seen (Figures 3 and 4). Histopathology result showed tan and sloughed mucosa, locular cyst in lumen of the gallbladder, findings consistent with chronic cholecystitis. One gallbladder showed chronic cholecystitis with cholelithiasis, with stone composition-mixed stones. While the other gallbladder showed mucocele with negative culture growth after bacteriology. The patient was discharged home the same day with no complications after receiving post-operative management.
Figure 1: Shows the pre-operative U/S image finding.
Figure 2: Shows the pre-operative CT image findings.
Figure 3: Intra-operative imaging of the duplicated gallbladder.