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

Highlights

• Duplication of gallbladder is a rare congenital anomaly that requires special attention.

• Preoperative diagnosis can be challenging to the surgeon who should be aware of the anatomic variations of the gallbladder and biliary system.

• Presence of cystic lesions adjacent to the gallbladder on imaging should raise the suspicion of gallbladder anomaly. Further diagnostic preoperative imaging is important to avoid surprises, complications and overlooking of a second gallbladder.

• MRCP is the imaging modality of choice for suspected duplicate gallbladder.

• We think the risks associated with laparoscopic cholecystectomy for duplicate gallbladders are comparable to those with non-duplicate gallbladder. However, these cases probably do better in the hand of an experienced laparoscopic surgeon or a hepatobiliary surgeon.

Abstract

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.