Complete laparoscopic cholecystectomy for a duplicated gallbladder: A case report

Abstract

Introduction: Duplication of the gallbladder (GB) is a rare congenital abnormality occurring in 1 in 4000 to 5000 births. Three types have been reported: type I (split primordial GB), type II (2 separate GBs with their own cystic ducts), and type III (triple GBs drained by 1 to 3 separate cystic ducts). Patients with a duplicated GB are usually asymptomatic and are sometimes not diagnosed on preoperative imaging, which might increase the difficulty and risk of cholecystectomy. The key to successful treatment is total removal of the duplicated GB to avoid the recurrence of disease. Intraoperative cholangiography is recommended for identifying and resecting duplicated GBs. The final diagnosis depends on the histopathology.

Patient concerns: A 62-year-old woman had recurrent upper abdominal pain and nausea for 1 year, with no fever, jaundice, or other symptoms. An ultrasound of the abdomen indicated polyps in the GB. Computed tomography (CT) revealed moderate dense structures attached to the wall of the GB and an unusual 47 × 21 mm elliptical structure with an extra tubule located above the main GB.

Diagnosis: A diagnosis of duplicated GB was made based on the histopathology.

Interventions: The patient underwent a laparoscopic cholecystectomy with total removal of the duplicated GB.

Outcomes: The patient's postoperative course was uneventful and she was discharged from the hospital on the second postoperative day. She had no upper abdominal pain at the 6-month follow-up.

Conclusion: Duplicated gallbladder is a rare congenital biliary anatomy, which is usually asymptomatic and sometimes cannot be diagnosed on preoperative imaging. With gallbladder disease, the duplicated GBs should be removed totally; a laparoscopic approach should be attempted first and cholangiography is recommended to aid in identifying and resecting the duplicated GBs. The final diagnosis depends on the histopathology. There is still insufficient evidence on the need to remove duplicated GBs found incidentally.

Figure 1

CT revealed an unusual elliptical dense mass (green arrow) with an extra tubular structure located above and medial to the native GB (yellow arrow), which measured about 47 × 21 mm². CT = computed tomography, GB = gallbladder.

Figure 2

MRCP indicated 2 separate GBs (green arrow) with their own cystic ducts connecting to the biliary tree. One contained bile of varying density and had a nonhomogeneous density structure. GB = gallbladder, MRCP = magnetic resonance cholangiopancreatography.

Figure 3

Illustration of our case: the double gallbladders with polyp.

Figure 4

The surrounding structures were dissected carefully and the cystic duct of each GB was exposed (green arrow). GB = gallbladder.

Figure 5

Two GBs were successfully resected. (A) We separated the 2 GBs and extracted bile from both. The bile was dark green in one and white in the other (B and C). The polypoid lesion was identified in the larger of the resected GBs (green arrow) (D). GB = gallbladder.

Figure 6

Histopathology indicated that one GB had a polyp (green arrow) and features of chronic cholecystitis; both lacked evidence of neoplasia. GB = gallbladder.

Figure 7

The Harlaftis classification of anatomical variation of accessory gallbladders.^[2]