Transcript 107_eposter - Stanley Radiology

Abstract number: 107
A RARE CASE OF DOUBLE
GALL BLADDER
CASE HISTORY
• A 60 year old female patient who was
asymptomatic and walked in for master health
checkup.
• On ultrasound abdomen , incidentally she was
found to have double gall bladder.
• Findings were reconfirmed with CT and MRCP.
ULTRASOUND ABDOMEN
• Two oblong anechoic structures closely
abutting each other noted in the gall bladder
fossa.
• No other associated abnormalities noted.
ULTRASOUND ABDOMEN
CT AND MRCP
• Subsequently CT and MRCP were performed
which revealed complete duplication of gall
bladder with a single cystic duct (Type I
duplication of Boyden’s classification) without
any co-existing pathology.
AXIAL CT
CORONAL CT
SAGITTAL CT
T1 AXIAL MRI
T2 AXIAL MRI
T2 CORONAL MRI
MRCP 3D
Lt Hepatic
MPD
CBD
DISCUSSION
• Double gallbladder is a rare congenital anomaly
• Boyden has classified double gallbladder into two
types;
• Type I: Vesica fellea divisa (Bilobed / bifid gall bladder,
double gall bladder with a common neck)
• Type II: Vesica fellea duplex (Double gall bladder with
two cystic ducts)
- Y shaped in which two cystic ducts are united
before entering the common bile duct
- H shaped in which two cystic ducts enter
separately in to common bile duct or hepatic duct.
DISCUSSION
• Classification by Harlaftis et al is based on morphology
and embryogenesis of two main groups and a third
miscellaneous group.
• The former is characterized by the presence of a single
cystic duct entering the common bile duct (Type l, that
is split primordium group).
• The accessory gallbladder group is characterized by
two cystic ducts opening separately into the biliary tree
(Type 2, that is accessory gallbladder group).
• The last is Type 3, the miscellaneous group which does
not fall into the foregoing two types
DIFFERENTIAL DIAGNOSIS
•
-
Differential diagnosis include
Gall bladder diverticula
Gall bladder fold
Phrygian cap
Choledocal cyst
Pericholecystic fluid
CONCLUSION
• Congenital anomalies of gall bladder and
anatomical variation of their positions are
associated with an increased risk of
complications after laparoscopic
cholecystectomy.
• Preoperative imaging should be useful for
diagnosis.
CONCLUSION
• Double gall bladder duplication is a rare
congenital anomaly.
• In case of any complications such as calculi,
complete pre operative assessment is
mandatory to prevent any inadvertent surgical
complications.
• In asymptomatic patients surgery is not
required.
REFERENCES
1.
2.
3.
4.
E. A. Boyden, “The accessory gallbladder: an embryological and
comparative study of aberrant biliary vesicles occuring in man and
the domestic mammals,” American Journal of Anatomy, vol. 38,
pp. 177–231, 1926.
F. Borghi, G. Giraudo, P. Geretto, and L. Ghezzo, “Perforation of
missed double gallbladder after primary laparoscopic
cholecystectomy: endoscopic and laparoscopic
management,” Journal of Laparoendoscopic and Advanced
Surgical Techniques, vol. 18, no. 3, pp. 429–431, 2008.
P. R. Kothari, T. Kumar, A. Jiwane, S. Paul, R. Kutumbale, and B.
Kulkarni, “Unusual features of gall bladder duplication cyst with
review of the literature,” Pediatric Surgery International, vol. 21,
no. 7, pp. 552–554, 2005.
M. Pitiakoudis, N. Papanas, A. Polychronidis, E. Maltezos, P.
Prassopoulos, and C. Simopoulos, “Double gall-bladder—two
pathologies: a case report,” Acta Chirurgica Belgica, vol. 108, no. 2,
pp. 261–263, 2008.
REFERENCES
5. R. Udelsman and P. H. Sugarbaker, “Congenital duplication
of the gallbladder associated with an anomalous right
hepatic artery,” American Journal of Surgery, vol. 149, no.
6, pp. 812–815, 1985.
6. Gigot J, Van Beers B, Goncette L, Etienne J. Collard A,
Jadoul P, Therasse A, Otte JB,Kestens P. Laparoscopic
treatment of gallbladder duplication-A plea for removal of
both gallbladder. Surg Endosc 1997; 11; 479-82.
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