Rosemary O.C. Oche, MD1, Konstantina Foufa, MD2, Ada M Krzak, BA3, Jan M Krzak, MD1. 1Department of Surgery South Jutland Hospital, Aabenraa, Denmark, 2Department of Radiology South Jutland Hospital, Aabenraa, Denmark, 3University of Cambridge, UK
Introduction: When searching for “Double Gallbladder” in PubMed, 129 results are obtained, many dated within the last decade (1). Unfortunately there are no publications from Denmark. We would like to present first to our knowledge reported case of double gallbladder in Denmark. Double gallbladder is a rare anomaly with a prevalence of 1:3800 in autopsy studies, described first by Boyden in 1926 (2). There are several classifications of double gallbladder that are based on relation between gallbladder, cystic duct and common bile duct (2,3). Non-specific symptoms and inadequate imaging are possible causes of lack of awareness of the condition. Removal of all gallbladders, preferably laparoscopic with special attention to the biliary anatomy, is recommended (4).
Method: Case report with review of the literature.
A 55-year-old female patient of Polish origin was hospitalized due to upper right quadrant pain. On admission clinical manifestations and paraclinical abnormalities of pancreatitis were present. Ultrasound scanning of the abdomen showed bile stones, ultrasonic manifestations of acute cholecystitis and normal intra- and extrahepatic bile ducts. Because of elevated liver enzymes MRCP was performed and showed double gallbladder, double cystic duct and signs of pancreas anulare. Scheduled ERCP confirmed bile stones in CBD, double gallbladder with double cystic duct, H-type according to Harlaftis classification (3). Because of minor retroperitoneal perforation second ERCP was needed for removal of all stones. The patient was then scheduled to laparoscopic cholecystectomy with perioperativ cholangiography.
Conclusion: Anatomical variations of the gallbladder such as double gallbladder are rare and often remain unnoticed. They are most often identified because of clinical manifestations symptoms, diverse imaging studies, during surgery or autopsy. As most of them are not expected, they can contribute to complications during surgery. Careful preoperative imaging is very important to prevent accidental bile duct injury. Looking at the number of case reports, double gallbladder seems to be slightly more common than expected. The interesting question is whether a gallbladder discovered during an unrelated radiological investigation in a patient that previously underwent a cholecystectomy can represent undetected case of double gallbladder. We would like to present a review of the literature as well as images from MRCP, ERCP and laparoscopy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87783
Program Number: P182
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster