A 59-year-old woman presented to our institution with 3 days of acutely worsening pain in the right upper quadrant, flank, and back. Her abdomen was significantly tender to palpation, with localized guarding in the right upper quadrant and epigastrium regions. Ultrasonography noted a moderately distended gallbladder with gallstones, but no gallbladder wall thickening or pericholecystic fluid. Abdominal computer tomography showed irregularity of the lateral wall of the gallbladder concerning for gangrenous cholecystitis and significant pericholecystic fluid collection (Figure 1). A second fluid collection seen medially could be due to either a duplicated gallbladder or a collection of pericholecystic fluid.
The patient was admitted, started on intravenous antibiotics, and consented for laparoscopic cholecystectomy. Intraoperatively, the cystic duct was observed to have 2 adjacent, thin caliber lumens (Figure 2). The gallbladder was removed and sent for immediate pathological gross analysis and confirmed to have 2 parallel lumens entering into separate halves of a bilobed gallbladder (Figure 3).
This report features the presentation of an uncommon anatomical variant of the gallbladder. Gallbladder duplication is a rare congenital malformation that occurs in approximately 1 in 4,000 births and can be categorized based on Boyden's classification.1 Although gallbladder duplication is uncommon, variations in the configuration of the biliary ductal and vasculature are common. The presence of these anatomic variants is often not identified until surgical procedure. Incidental injury to these structures is of extreme concern during laparoscopic cholecystectomy and highlights the importance of the surgeon understanding of these variants.2
Laparoscopic cholecystectomy of a duplicated gallbladder has been described in multiple previous reports.3,4 There have been reports where selective removal of only the affected gallbladder was performed in patients with gallbladder duplication and disease in only 1 of the 2 organs. In a report, acute cholecystitis developed in the remaining organ, requiring a second operation for gallbladder removal.5 Therefore, in cases of gallbladder disease involving only 1 of the duplicated gallbladders, it is recommended to remove both organs during the same procedure, as was performed in our case. However, prophylactic cholecystectomy in asymptomatic patients with gallbladder duplication is not indicated as there does not seem to be a significantly increased risk of developing gallbladder disease in these patients.2
Author contributions: All authors contributed equally to this manuscript. LT DiFazio is the article guarantor.
Financial disclosure: None to report.
Informed consent could not be obtained for this case report. All identifying information has been removed.
1. Boyden EA. The accessory gallbladder- an embryological and comparative study of aberrant biliary vesicles occurring in man and the domestic mammals. Am J Anat. 1926;38(2):177–231.
2. Udelsman R, Sugarbaker PH. Congenital duplication of the gallbladder associated with an anomalous right hepatic artery. Am J Surg. 1985;149(6):812–5.
3. Rawahi AA, Azri YA, Jabri SA, Alfadli A, Aghbari SA. Successful laparoscopic management of duplicate gallbladder: A case report and review of literature. Int J Surg Case Rep. 2016;21:142–6.
4. Desolneux G, Mucci S, Lebigot J, Arnaud JP, Hamy A. Duplication of the gallbladder. A case report. Gastroenterol Res Pract. 2009;2009:1–3.
5. Gigot JF, Beers BV, Goncette L, et al. Laparoscopic treatment of gallbladder duplication. Surg Endosc. 1997;11(5):479–82.