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.
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4.
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P. R. Kothari, T. Kumar, A. Jiwane, S. Paul, R. Kutumbale, and B.
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M. Pitiakoudis, N. Papanas, A. Polychronidis, E. Maltezos, P.
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REFERENCES
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