Gallbladder duplication: MR cholangiography demonstration

A Rare Incidental Finding of Phrygian Cap in a Case of Pyloric Perforation

Deviation from the normal development of the biliary tree and gall bladder gives rise to numerous different types of anomalies. One of the anomalies is the Phrygian cap. The Phrygian cap is an even rarer condition. We report a case that was asymptomatic. In a rare case, the Phrygian cap anomaly may cause symptoms that are mainly due to superadded cholelithiasis. A detailed pre-operative history and thorough physical examination should be done. Many of the cases may be missed during the routine examination. The diagnosis, with the help of radiological investigations, will be helpful to keep the location and anatomy of the anomalous gall bladder in mind during the intra-operative period. The patient was operated on to seal off a perforation, where a Phrygian cap was observed as an incidental finding. The patient did not have any complaints pointing toward the presence of cholelithiasis or cholecystitis. Due to the asymptomatic incidental presentation of the condition, the operating surgeons decided on avoiding further dissection and an increase in the morbidity load. Thus, we report this case to focus on this rare entity and consider it a differential while dealing with a case of pain in the abdomen.

Gallbladder duplication complicated by cholecystitis and unsuspected choledocholithiasis: A case report and review of literature

Introduction

Gallbladder duplication is a rare congenital anomaly of the biliary tree. Although a double gallbladder by itself is not clinically significant, complications of gallstone disease increases the complexity of the management. Preoperative recognition decreases the risk of complications during laparoscopic cholecystectomy.

Presentation of case

Presented herein is the case of a 52 year old who presented with abdominal pain. A transabdominal ultrasound was suggestive of a gallbladder duplication with the larger gallbladder filled with cholelithiasis. Subsequent imaging studies, including an endoluminal ultrasound, confirmed the diagnosis and documented a choledocholithiasis. Endoscopic extraction of the biliary stone with subsequent laparoscopic cholecystectomy of both gallbladders was successfully performed.

Discussion

This case is being presented not only for the rarity of the condition but also of the challenges in management it poses. In gallbladder duplication, pathologic involvement of one gallbladder requires removal of both gallbladders. A high index of suspicion on initial scanning warrants further delineation of the important anatomic structures of the biliary tree to avoid perioperative complications.

Conclusion

Laparoscopic cholecystectomy may be safely performed in patients with gallbladder duplication. Preoperative recognition with appropriate imaging modalities, including ultrasound and MRCP may avoid surgical complications. In cases where the anomaly is detected intraoperatively during cholecystectomy, meticulous dissection and intraoperative cholangiography will avoid iatrogenic injuries and lead to successful outcomes.

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Gallbladder duplication is a rare congenital malformation.

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Gallbladder duplication complicated by calculous cholecystitis and choledocholithiasis is extremely rare.

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Preoperative recognition with appropriate imaging modalities is important to avoid perioperative complication.

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Meticulous dissection and intraoperative cholangiography may avoid injury during surgery when recognized intraoperatively.

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Laparoscopic removal of both gallbladders is indicated in cases with gallstone disease.

Duplicate gallbladder: A case report of a patient with cholecystitis after cholecystectomy

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Cholecystitis after cholecystectomy raises suspicions for duplicate gallbladder.

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Imaging techniques demonstrating biliary anatomy can diagnose duplicate gallbladder.

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Duplicate gallbladders arise from either a common or duplicate primordium.

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Gallbladder disease is sufficient indication for resection of duplicate gallbladder.

Introduction

Duplicate gallbladder is a congenital anomaly with various anatomical presentations that can pose difficult diagnostic dilemmas. This case presents the consequence of recurrent cholecystitis after prior cholecystectomy due to delay in diagnosis of a duplicate gallbladder and insufficient treatment at first presentation. It also provides the opportunity to discuss the anatomical variations of duplicate gallbladders and their clinical implications.

Presentation of case

We report on a 46-year-old woman who presented with symptoms of cholecystitis despite a history of cholecystectomy. Magnetic resonance cholangiopancreatography (MRCP) as well as review of intraoperative cholangiogram from the index surgery identified a cystic structure continuous with the biliary tree. Laparoscopic cholecystectomy was performed and histology confirmed a duplicate gallbladder. The patient did well post-operatively without any complications.

Discussion

Harlaftis’s classification of duplicate gallbladder categorizes anatomical variations based on embryological origin. Though rarity contributes to missed diagnosis, modern imaging techniques that delineate the biliary tree can identify these abnormalities. Recognizing these variations can identify risk for recurrent disease preoperatively and thereby guide surgical decision-making.

Conclusion

Duplicate gallbladder poses a risk for the unique presentation of recurrent cholecystitis despite cholecystectomy. Advanced imaging techniques that demonstrate biliary anatomy can identify duplicate gallbladder perioperatively. For those presenting with disease in any one gallbladder, resection of both is ideal to prevent recurrence of disease.

Duplicated gall bladder with gall bladder polyp presenting with cholecystitis: Case report with literature review

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Duplicated gall bladder is a very rare finding.

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Complete identification of the anatomy is required before cholecystectomy.

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Sometimes one of the gallbladders may be missed during the first surgery which may require another operation.

Introduction

Gall bladder anomalies may be in the form of abnormalities in the shape, position, or number. It could be true duplication being completely separated or Y-shaped being united with single cystic duct.

Presentation of case

A 38-year-old lady presented with frequent attacks of right hypochondrial pain for the last 4 months. Ultrasound of the abdomen showed distended gall bladder with 1.3 cm gall bladder polyp at the region of the fundus. Decision done for laparoscopic cholecystectomy. During surgery a duplicated gall bladder found with single cystic duct. Successful surgery done and the gall bladder sent for the histopathological examination which showed a benign gall bladder polyp. There were no post-operative complications and the patient discharged on the third days.

Discussion

Duplicated gall bladder may be diagnosed with ultrasound or magnetic resonance cholangiopancreatography (MRCP) which is the investigation of choice however most cases diagnosed intraoperatively. It may be associated with other biliary anomalies. In some occasions a single gall bladder may be removed during the first operation and the second may be missed which require another surgery. In asymptomatic individuals with duplicated gall bladder no specific treatment is required and role of surgery is controversial.

Conclusion

duplicated gall bladder is a rare finding which may be completely asymptomatic. In symptomatic patients specially if associated with gall stones, surgery is required and the surgeon must be aware of any associated biliary anomalies.

Laparoscopic management of 'Y-shaped' gallbladder duplication with review of literature

Gallbladder duplication is a rare congenital malformation that occurs in about 1:4000 cases. Congenital anomalies of the gallbladder and anatomical variations of their position are associated with an increased risk of complications during laparoscopic cholecystectomy. We report a case of gallbladder duplication with symptomatic cholelithiasis, who presented with recurrent episodes of biliary colic and subsequently underwent laparoscopic cholecystectomy with intraoperative cholangiography. We also discussed in brief about the available literature support in relation to incidence of this disorder, imaging modalities used, intraoperative strategies and recommended measures for safe outcomes.

Successful laparoscopic management of duplicate gallbladder: A case report and review of literature

INTRODUCTION

Gallbladder duplication is a rare congenital anomaly. Recognition of this anomaly and its various types is important since it can complicate a simple hepatobiliary surgical procedure.

PRESENTATION OF CASE

We report a case of a 42 year old female who presented a 6 year history of intermittent right upper quadrant abdominal pain. Her basic blood investigations including liver function tests were normal. Pre-operative imaging revealed a cystic lesion communicating with biliary tree representing duplicated gallbladder. She subsequently underwent successful laparoscopic cholecystectomy. The operative challenges were more than those anticipated at the usual laparoscopic gallbladder procedures. After six months follow up the patient remained asymptomatic.

DISCUSSION

Preoperative diagnosis plays a crucial role in planning surgery, and preventing possible biliary injuries or re-operation if accessory gallbladder has been overlooked during initial surgery. Magnetic resonance cholangiopancreatography (MRCP) is the imaging modality of choice for suspected duplicate gallbladder. Laparoscopic cholecystectomy for duplicate gallbladder is a challenging operation and should be performed with meticulous dissection of the cysto-hepatic triangle.

CONCLUSION

Gallbladder anomalies should be anticipated in the presence of a cystic lesion reported around the gallbladder. The laparoscopic cholecystectomy remains feasible for intervention and should be done by an experienced laparoscopic surgeon.

Single Incision Laparoscopic Cholecystectomy for Gallbladder Duplication

Duplication of the gallbladder is a rare congenital anomaly of the gallbladder, with an estimated prevalence of 1-3 per 3800 individuals. Unless properly diagnosed preoperatively, it can lead to biliary tract injuries and postoperative complications which may require reoperative surgeries. While previously reported cases have been treated with conventional laparoscopic cholecystectomy (LC), treatment with single incision laparoscopic surgery (SILS) has not been reported yet. We herein present the case of a 58-year-old female with gallbladder duplication who was successfully treated with SILS cholecystectomy.

A new variant of cholecystohepatic duct: MR cholangiography demonstration

Magnetic resonance cholangiography used before laparoscopic cholecystectomy may reduce the incidence of post-operative complications related to the high anatomic variability of the biliary system. A number of anatomic variants of the biliary tree have been reported. We present a rare case in which magnetic resonance cholangiography demonstrated a new variant of the cholecystohepatic bile duct acting as a communication between the gallbladder fundus and an intrahepatic biliary duct.

Double gallbladder completely enclosed in a cystogastric fold of peritoneum

Double gallbladder is one of the rare congenital anomalies of the gallbladder. Failure to detect an accessory gallbladder hampers diagnosis and treatment of cholecystitis, which might result in recurrent attacks of cholecystitis. In addition, presence of peritoneal folds extending from the stomach and duodenum to the gallbladder is very rare. Here we report the presence of a double gallbladder enclosed in a cystogastric fold of the peritoneum. During cadaveric dissection, we observed a cystogastric peritoneal fold that extended from the lesser curvature of the stomach and the first part of the duodenum to the gallbladder. The left end of the peritoneal fold merged with the lesser omentum. It enclosed two gallbladders: the main gallbladder and a small accessory gallbladder. The accessory gallbladder was a small pouch with its fundus attached to the main gallbladder by fibrous tissue, and its duct opened into the main cystic duct.

Laparoscopic cholecystectomy in double gallbladder with dual pathology

Double gallbladder is a rare embryological anomaly of clinical significance. Despite availability of modern imaging, only 50% of recently reported cases had preoperative diagnosis, which is desirable in every case to avoid serious operative complications. Double pathology in double gallbladder is extremely rare with only 3 reporting's available till date to the best of author's knowledge. With a preoperative diagnosis of double gallbladder, laparoscopic cholecystectomy can be safely and successfully performed with meticulous dissection, aided by operative cholangiogram. However in all such attempts a lower threshold should be kept for conversion to open surgery. Awareness about this anomaly amongst radiologists and surgeons is of crucial importance. Double gallbladder does not present with any specific symptom, neither it increases disease possibility in either lobe. Prophylactic cholecystectomy has no role in asymptomatic cases diagnosed accidentally. Author reports a case of a symptomatic young male with double gallbladder who presented with short history of dyspepsia, abdominal pain and fever. Definite preoperative diagnosis was reached with ultrasound scan and magnetic resonance cholangio pancreatography and subsequently dealt with laparoscopically. Calculous cholecystitis affected one lobe and acalculous empyema the other. While the 1st lobe drained though a cystic duct into common bile duct (CBD), the 2nd was without any communication with either CBD or its counterpart, thus remained as a blind vesicle.

Double gall bladder-a rare entity

Cholecystectomy is the most commonly performed operation in surgery. Variations inanatomical disposition are not infrequent. However variations in number of cystic ductand gall bladder is quiet rare. This poses a diagnostic and management problem withcomplications during surgery and missed gall bladder being reported in world literature. We here by report a case of double gall bladder with double cystic duct that was managed by laparoscopic surgery.

Combined use of ultrasonography, MDCT and MRCP for the diagnosis of gallbladder duplication: case report

Gallbladder duplication is a rare congenital anomaly, and the exact diagnosis of this pathology is important for preventing any clinical and surgical problems. Multidetector computed tomography (MDCT) and magnetic resonance cholangiopancreatography (MRCP) have increasing values in the diagnosis of gallbladder duplication. In this case report we present an evaluation and exact diagnosis of gallbladder duplication using ultrasound, MDCT and MRCP.

Duplication of the gallbladder. A case report

Gallbladder duplication is a rare anatomic malformation, which can now be detected by preoperative imaging study. We report a case of a symptomatic duplicated gallbladder, successfully treated by laparoscopic cholecystectomy. This anomaly is important to know for surgeons because of associated anatomical variations of main bile duct and hepatic artery and increased risk of common bile duct injury.

Cholecystitis of a duplicated gallbladder complicated by a cholecystoenteric fistula

Gallbladder duplications are uncommon anatomic variants that are sometimes mistaken for other entities on imaging. We present a surgically confirmed case of cholecystitis in a ductular-type duplicated gallbladder complicated by the formation of an inflammatory fistula to the adjacent duodenum. Both US and magnetic resonance cholangiopancreatography were performed preoperatively, in addition to intraoperative cholangiography, which confirmed the presence of a duplicated gallbladder.

Neuroma of a double gallbladder: a case report

We report a case of 55 year old male patient who presented with recurrent upper abdominal pain following a laparoscopic cholecystectomy. A subsequent diagnostic laparoscopy revealed the presence of a second gallbladder which was initially missed. The peculiarity of his symptoms can in part be explained by the presence of a traumatic neuroma in his second gallbladder. A subsequent cholecystectomy led to a complete resolution of this patient's signs and symptoms. As far as we know this is the first report in the literature of a traumatic neuroma in a second gallbladder.

Congenital anomalies and variations of the bile and pancreatic ducts: magnetic resonance cholangiopancreatography findings, epidemiology and clinical significance

PURPOSE

The objective of this paper is to document the magnetic resonance cholangiopancreatography (MRCP) findings and the epidemiology of congenital anomalies and variations of the bile and pancreatic ducts and to discuss their clinical significance.

MATERIALS AND METHODS

Three-hundred and fifty patients of both sexes (150 females, 200 males, age range 0-76 years, average age 38 years) underwent MRCP for clinically suspected lithiasic, neoplastic or inflammatory disease of the bile and pancreatic ducts. Patients were imaged with a 1.5-T superconductive magnet (Magnetom Vision, Siemens, Erlangen, Germany), a four-channel phased-array body coil, breath-hold technique, with multislice T2-weighted half-Fourier acquisition single-shot turbo spin echo (HASTE), MIP reconstructions, and a single-shot T2-weighted turbo-spin-echo sequence rapid acquisition with relaxation enhancement (RARE) with different slice thicknesses. Studies in oncological patients were completed with fat saturation 3D T1 gradient-echo sequences during the intravenous injection of gadolinium diethylene triamine pentaacetate acid (DTPA) (0.2 ml/kg).

RESULTS

MRCP demonstrated recurrent and therefore normal bile and pancreatic ducts in 57% of patients. In the remaining 42.3%, it documented anatomical variants (41%) and congenital anomalies (1.3%). Variants of the intrahepatic bile duct were seen in 21% of cases: crossover anomaly (6.7%), anterior branch of the right hepatic duct draining the IV and VII segments that flow together with the left bile duct (3.1%) and anterior and posterior branches of the right hepatic duct that flow together with the common hepatic duct (3.3%). Variants of the extrahepatic bile ducts were present in 8.8% of patients: low insertion of the cystic duct into the common hepatic duct (4.5%), emptying of the cystic duct into the right hepatic duct (2.7%) and a second-order large branch draining into the cystic duct (1.6%). MRCP identified a double gall bladder in 3% of patients and anatomical variants of the biliopancreatic system in 8.2%: pancreas divisum (5.2%) and a long sphincter of Oddi (3%). Finally, congenital anomalies were diagnosed in 1.3% of cases: bile duct cysts (0.3%), atresia of the bile ducts (0.3%) and multiple biliary hamartomatosis (0.7%).

CONCLUSIONS

The congenital anomalies and anatomical variants of the bile and pancreatic ducts present a complex spectrum of frequent alterations, which are worthy of attention in both the clinical and surgical settings and are readily identified by MRCP.

Duplicate gallbladder: an unusual case report

Duplication of the gallbladder, a rare congenital anomaly, is important in clinical practice as it may cause some clinical, surgical and diagnostic problems. In this report we present a case of duplicated gallbladder diagnosed serendipitously in a 63-year-old male patient who had previously undergone successful laparoscopic cholecystectomy (confirmed histologically) approximately a year before for gallstones. The patient was re-admitted with obstructive jaundice. An abdominal computed tomography scan and magnetic resonance cholangiogram both revealed the presence of a gallbladder, which was thereafter removed at surgery undertaken to palliate the jaundice.

Laparoscopic Cholecystectomy for a Double Gallbladder of the Duodenal Type

Double gallbladder is a rare congenital malformation and generally considered a duplication of 1 primordium. We encountered an extremely rare case of double gallbladder of the duodenal type that was considered a duplication of 2 primordia. We were able to diagnose the anomaly preoperatively by endoscopic retrograde cholangiopancreatography and spiral computed tomography after intravenous infusion cholangiography, and laparoscopic removal was successfully performed. To our knowledge, this is the first reported case of double gallbladder of the duodenal type that was diagnosed preoperatively and treated successfully by laparoscopic removal.

Bilobed gallbladder diagnosed by oral cholecysto-CT

Morphological anomalies of the gallbladder are rare and are characterized by a large variety of configurations depending on the size and degree of fusion of the lobes, and on the number and position of the cystic ducts. We presented a case of bilobed gallbladder incidentally detected during abdominal ultrasonography. Oral cholecystography and computed tomographic examination after oral cholecystography (Oral Cholecysto-CT) were performed to confirm this abnormality. This is a quite rare anomaly consisted of complete duplication of the fundus and partially duplication of the corpus and separated lobes both of which entered a single infundibulum and cystic duct.