Case Report Open Access J Surg
Volume 9 Issue 5 - October 2018
Copyright © All rights are reserved by Bhaskar Chintakayala
DOI: 10.19080/OAJS.2018.09.555773
Duplication of Gallbladder
Bhaskar Chintakayala*
Department of General and Minimal access surgery, India
Received: May 07, 2018; Published: October 15, 2018
*Corresponding author: Bhaskar Chintakayala, General surgeon resident, Maharaja Agrasen Hospital, Department of General and Minimal access
surgery, New Delhi, India; Email:
Abstract
Anatomical variations of gallbladder are being rare entity and duplication is one of the variants with two funds of gallbladder communication
through a common channel cystic duct to the bile duct. Incidence of Gallbladder duplication has been reported 1:4000 in the literature. We report
a case of incidental finding of gall bladder duplication during laparoscopic cholecystectomy for symptomatic cholelithiasis with both the fundus
harbouring gallstones with a single cystic duct and two cystic arteries. Surgery was successful with both gallbladders removed and no post-
operative complication reported. This case emphasises the need for removal of both the gallbladders in the same setting with recognition of
possible vascular and biliary aberrant anatomy to avoid and complication during surgery.
Keywords:Duplicated gallbladder; Aberrant biliary anatomy;Fundus duplication;Laparoscopic cholecystectomy
Introduction
for precise plan of management and to make sure both the
Aberrant anatomy of biliary structures like duplication of
gallbladders are removed completely without complications. As
gallbladder is one of the rare presentations occurring in 1:3800-
these anomalies are frequently associated with stone formation
4000 births [1]. These congenital anomalies pose a definite risk
due to inadequate bile drainage. Laparoscopic cholecystectomy is
of biliary injury during operative interventions like laparoscopic
the treatment of choice.
cholecystectomy. Precise diagnosis pre-operatively is required
Case Report
Figure 1: Boyden’sclassificationcongenitalduplicationofgallbladder.
Open Access J Surg 9(5): [Link].555773 (2018) 001
Open Access Journal of Surgery
We report a case of incidentally finding of duplicated are those that became symptomatic or were encountered as inci-
gallbladder during intra operative procedure of laparoscopic dental findings during surgery, imaging studies or at autopsy. Usu-
cholecystectomy for symptomatic cholelithiasis in a 38yr lady. ally present with similar complaints as with normal gallbladder
She presented to the OPD with complaints of recurrent pain in disease and as there is no significant risk for subsequent disease,
the right upper quadrant region for 4months with fatty meal prophylactic cholecystectomy in an asymptomatic patient with
intake. Her medical history was not contributory and no history gallbladder duplication is not recommended.
any interventions in the past. Clinically her abdomen was soft,
Diagnosis
no tenderness or distention with no palpable lumps and no signs
of jaundice. Her blood workup was normal, and USG revealed a Gallbladder duplication can be detected preoperatively by
large dissented gallbladder with multiple calculi and sludge with imaging studies. USG is generally the first choice of imaging
no signs of cholecystitis. Patient was taken up for laparoscopic modality in patients with suspected biliary disease. USG may
cholecystectomy after taking proper informed consent. After diagnose gallbladder duplication if the viscera are located
introduction of scope we noticed a usually large gallbladder upon separately may suggest a double gallbladder, the cystic duct is
exploration duplication of fundus of gallbladder was evident usually not identified, and it is often impossible, as in our case,
opening through a common channel cystic duct as shown in to distinguish bilobed gallbladder from a distended gallbladder.
(Figure 1). During calot’s dissection two cystic arteries were MRI or a CECT would be more valuable in visualising duplicated
encountered and were carefully clipped and divided. The common gallbladder preoperatively [7,8].
cystic duct was clipped and divided, and gallbladder extracted Management
with no complications. Patient recovered well and was discharged
Laparoscopic cholecystectomy would be advised for patients
the next day and she was followed further and no complication
with symptomatic cholelithiasis with preoperatively detached
were reported.
duplicated gallbladder with no evidence for intervention in
Discussion asymptomatic incidentally discovered duplicated gallbladder.
Incidence Conclusion
Congenital variation of anatomy of gallbladder are rare. Duplication of gallbladder is a rare congenital anomaly which
Duplication of gallbladder is one such variant occurring in 1 of requires attention as it is often associated with other aberrant
every 3800-4000 births [1]. It is thought to be due to exuberant anatomy cystic duct hepatic and cystic artery. Careful delineation
budding of the developing biliary tree during the division of of anatomy preoperative or intraoperatively may be required in
caudal bud of hepatic diverticulum. The first reported human case such cases.
was noted in a sacrificial victim of Emperor Augustus in 31 BC. It
References
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Clinical Features
Duplicated gallbladder is a rare anomaly that cannot be accu-
rately assessed, since the only cases which have been identified
002 How to cite this article: Bhaskar C. Duplication of Gallbladder. Open Access J Surg. 2018; 9(5): 555773. DOI: 10.19080/OAJS.2018.09.555773.
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003 How to cite this article: Bhaskar C. Duplication of Gallbladder. Open Access J Surg. 2018; 9(5): 555773. DOI: 10.19080/OAJS.2018.09.555773.