Abdulaziz A Arishi, MD, Amin M Ahmad, MD, Wesley C Judy, David Heidt, MD. University of Toledo Medical Center
Introduction: Double gallbladder is an uncommon condition. The incidence of Double gallbladder alone is about 1 in 3000-4000 cases where the incidence of choledochal cyst is ranging from 1 in 13 000 persons to 1 in 200 000 persons. There is no known reported case of both anomalies in a single patient.
Presentation of case: This is a 26-year-old male who presents with intermittent right upper quadrant abdominal pain for one month associated with nausea and no vomiting. Ultrasound of abdomen revealed duplications of gallbladder. MRCP shows duplication of gallbladder, and Type I choledochal cyst. No family history of cancer. He underwent an exploratory laparotomy, cholecystectomy, common bile duct resection, and hepaticojejunostomy.
Discussion: Double gallbladder and choledochal cyst are well described rare clinical entities. Classification system of abnormal anatomic variation of gallbladder was developed by Harlaftis and Boyden. Proposed theories of embryologic development suggest that it develops either as a bifurcation of the cystic primordia or duplication of it. Gallbladder duplication can be classified as a type-I anomaly a split primordial gallbladder, where gallbladder can be partially, incomplete or completely split. Type-II anomaly, which is the most common, where two separate gallbladders, each with their own cystic duct, or a rare type-III anomaly, where triple gallbladders draining by 1–3 separate cystic ducts. In other hand choledochal cyst was classified by Todani into five types based on location and the degree of biliary tract dilation. Choledochal cyst are associated with high risk of cholangitis, pancreatitis, and cancer development. Surgery is indicated to prevent those complications.
Conclusion: The important point of this case is the unusual presentation of two relatively rare congenital conditions. A literature search showed an absence of similar cases ever being reported. Knowledge of anatomy and high level of alertness for congenital abnormalities is key for safe surgical operation. Failure to recognize those anomalies are associated with increased operative difficulty and complications.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94028
Program Number: P256
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster