Joshua Klein, DO1, Jason Kasenberg, DO1, Barry Sussman, MD2, Maurizio Miglietta, DO1. 1Hackensack University Medical Center at Palisades, 2Englewood Hospital and Medical Center
Introduction: Congenital gallbladder duplication (CGD) is a rare anatomic anomaly that occurs when there is abnormal embryologic development during gestation. While numerous cadaveric studies have estimated the incidence to occur in 1: 4,000 individuals, the true incidence is unknown. For patients with benign gallbladder disease, Laparoscopic Cholecystectomy (LC) has become the standard of care. Many variations of biliary anatomy have been described in the literature with aberrant anatomy having a positive correlation with bile duct injuries. This case report looks at a patient with benign gallbladder disease who was found to have CGD and discusses laparoscopic considerations that should be taken into account during LC.
Case: 32 year old female presented with recurrent right upper quadrant pain for one year. The patient underwent an ultrasound that showed cholelithiasis within two fluid filled structures. All hematologic and chemistry panels were within normal limits. A MRI/MRCP was ordered to evaluate the anatomy more precisely, which revealed two completely separate gallbladders draining into a common cystic duct. The patient underwent a successful elective laparoscopic cholecystectomy and was discharged home later in the afternoon.
Discussion: Gallbladder duplication requires special considerations intra-operatively in order to avoid potential complications. There have been numerous reports detailing the various forms of biliary anatomy encountered in patients with CGD. Y-type cystic anatomy, in which there is a common insertion of the cystic duct into the extrahepatic bile duct and H-type cystic anatomy, in which there are separate insertions into the extrahepatic bile duct remain the most common forms. Concurrent removal of both gallbladders during surgery is recommended in order to prevent symptoms of biliary colic or cholecystitis in the remaining gallbladder. Due to the atypical anatomy, patients with gallbladder duplication have higher incidences of cystic artery avulsion, postoperative bile leaks, and bile duct injuries. Intraoperative cholangiography is benificial in better defining the abnormal biliary system associated with CGD and is useful in preventing complications.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80688
Program Number: P141
Presentation Session: Poster (Non CME)
Presentation Type: Poster
