Figure - available via license: CC BY
Content may be subject to copyright.
![Double gallbladder as classified by Gross [3].](publication/46111206/figure/fig4/AS:323633290465287@1454171597370/Double-gallbladder-as-classified-by-Gross-3.png)
Source publication
![Double gallbladder as classified by Gross [3].](publication/46111206/figure/fig4/AS:323633290465287@1454171597370/Double-gallbladder-as-classified-by-Gross-3_Q320.jpg)
Double gallbladder is a rare congenital biliary anomaly, but an accessory gallbladder arising from the left hepatic duct is a more remarkably rare congenital anomaly. We report a case of double gallbladder with adenocarcinoma and gallstones, which was preoperatively diagnosed by endoscopic retrograde cholangiopancreatography (ERCP) and then confirm...
Similar publications
BACKGROUND: Gallstone ileus is a misnomer of intestinal obstruction. This rare entity of gallstone disease happens after episodes of acute cholecystitis, Mirizzi's syndrome, or even after endoscopic intervention.
CASE REPORT: A 17-year-old lady with acute cholecystitis, hepatolithiasis, and choledocholithiasis was endoscopically managed through end...
Citations
... This case report highlights the diagnosis and management of a suspicious mass identified within a duplicated gallbladder that was proven to be adenocarcinoma requiring a hepatic resection intraoperatively. To our knowledge, only six reported cases exist describing such a presentation in the literature with relative paucity of expert opinion on approaches to medical and surgical management [3][4][5][6][7][8][9]. ...
... A duplicated gallbladder can often appear similarly to a Todani II bile duct cyst on imaging, which is known to have an increased risk of malignancy [14]. Malignancy within duplicated gallbladders has been described in several case reports [3][4][5][6][7][8][9]. There are currently no formal guidelines for management of this extremely rare presentation. ...
Identifying a duplicated gallbladder is a rather rare entity, but a well-described phenomenon within the current literature. Although this finding has been described in numerous case reports, management remains poorly defined and the diagnosis is often difficult. We present a case of a patient with a suspected duplicated gallbladder versus a choledochocele that was diagnosed later on with adenocarcinoma within a duplicated gallbladder during surgical management requiring extended hepatic resection for curative intent. This case emphasizes the importance of radiological techniques in diagnosing such rare cases and the surgical approach of managing adenocarcinoma in the presence of this rare anatomical malformation.
... Gallbladder (GB) duplication is an uncommon congenital anomaly which occurs in approximately 1 in every 4000 people. [1][2][3] However, they are not identified unless they become symptomatic with GB pathology such as cholecystitis/cholangitis needing procedures such as cholecystectomy/endoscopic retrograde cholangiopancreatography or incidentally found in imaging or during autopsy. Duplication of the gallbladder is associated with an increased risk of cholecystic complications including cholecystitis and cholelithiasis. ...
... Only 5 reported cases of this coincidence have been identified in a recent literature review. [2,[5][6][7][8] We present a rare case of Adenocarcinoma which was found incidentally during laparoscopic cholecystectomy of a Y-insertion GB duplication. ...
Rationale:
Gallbladder cancer is the most common malignancy of the biliary tree. Despite this, the only curative therapy remains surgical resection of the lesion achieving microscopically clear margins before malignant spread has occurred. Gallbladder duplication is an uncommon anatomical variance which occurs globally. It can present in a range of ways dependent on the embryological origin of the variance.
Case:
A 52-year-old female presented for planned laparoscopic cholecystectomy in the context of cholelithiasis resulting in recurrent biliary colic. The patient had no personal history of malignancy or significant medical comorbidities.
Diagnosis:
Intraoperatively, the patient was found to have Y-insertion variation of gallbladder duplication. Histopathology of the resected gallbladders showed an incidental invasive gallbladder adenocarcinoma affecting one of the gallbladders.
Intervention:
Both gallbladders were laparoscopically resected en-bloc.
Outcomes:
The patient underwent oncology staging, which found no evidence of metastatic spread. Regular surveillance is attended with no recurrence of disease identified.
Conclusion:
There are few reported cases detailing the occurrence of gallbladder adenocarcinoma in the presence of duplication of the gallbladder. This case demonstrates the clinical benefit of R0 surgical resection of gallbladder cancer, whilst highlighting the difficulties of diagnosing duplication of the gallbladder or gallbladder adenocarcinoma.
... Studies on MGs were identified in PubMed by searching for the words "multiple gallbladders," "duplicated gallbladder," "duplication of gallbladder," "duplicate gallbladder," and "double gallbladder" corresponding to the definition of true duplication according to Boyden's classification. Furthermore, only five cases of gallbladder malignancy with MGs, except for MGs in a broad sense, have been reported in the English literature [2][3][4][5][6]; little is known about MGs associated with carcinoma. We herein report a rare case of MGs associated with carcinoma. ...
... In addition, celiac angiography demonstrated the unusual form of the intrahepatic artery that enveloped the cystic tumor, and they noted that it might be a diagnostic characteristic of accessory gallbladders. Kawanishi et al. reported carcinoma visualized with abnormal accumulation by FDG-PET [5]. Well-differentiated tubular adenocarcinoma with infiltration into the submucosal layer was observed in the resected accessory gallbladder. ...
... c, d Hematoxylin and eosin (H&E) staining at original magnification (× 20 and × 100). Pedunculated and non-invasive mucosal carcinoma had a fine stalk, and there was space between the mass and the gallbladder wall [5]. Although we recognized the importance of FDG-PET, we could not reconcile the differences in these results. ...
Introduction:
Multiple gallbladders represent a rare congenital disorder, and coexistence with carcinoma is extremely rare, leading to a high possibility of misdiagnosis and surgical complications. In this study, a case was reported and the literature was reviewed.
Case presentation:
An 80-year-old woman was diagnosed with acute cholecystitis via ultrasonography and was successfully treated with antibiotics. After the patient's biliary colic relapsed, she was referred to our hospital. Multiple imaging modalities revealed duplication of her gallbladder (H-type) and suggested coexistence with carcinoma. According to preoperative evaluations, we assumed the patient had stage IIIA disease, and cholecystectomy, cholangiography using a near-infrared ray vision system, and sectionectomy of segments 4a and 5 were performed. Contrary to the high standardized uptake values obtained by 18F-fluoro-2-deoxy-D-glucose positron emission tomography, gallbladder carcinoma was pathologically diagnosed as stage 0 mucosal cancer. Seven days after the operation, portal thrombosis of the posterior branch was revealed, and conservative therapy was indicated; satisfactory results were achieved. The patient was discharged 65 days after surgery. No recurrence was observed for 1 year after surgery.
Conclusions:
An extremely rare case of malignancy in a duplicated gallbladder was reported, and the literature was reviewed. Accurate estimations are feasible for diagnoses of multiple gallbladders, where correct evaluations are vital, especially in malignant cases. Because of the possibility of malignancy, resected accessory gallbladders should be scrutinized pathologically.
... In type II anomalies, the most common form, 2 separate GBs drain into a common bile duct through independent cystic ducts (H-type), or one of the cystic ducts drains into the right or left hepatic duct (trabecular type) (Fig. 7). [2,3] Kawanishi et al [8] reviewed 148 cases of duplicated GB and concluded that the H-type was the most common, accounting for nearly half of the reports. A type III anomaly is one that does not fit either type I or II, involving triple GBs draining through 1 to 3 separate cystic ducts. ...
... A type III anomaly is one that does not fit either type I or II, involving triple GBs draining through 1 to 3 separate cystic ducts. [5,8,9] Cases of duplicated intrahepatic GBs have also been reported. Won et al [10] reported a duplicated gallbladder in an intrahepatic location mimicking a cystic intraductal papillary neoplasm of the bile duct. ...
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.
... Furthermore, some embryologic biliary malformations, such as bile duct cysts or pancreatico-biliary maljunction, may be at risk of malignant transformation. Malignancy within MG has been reported; 8,9 there is, however, currently no clear evidence of cancerous risk associated with such embryologic malformations, and no recommendations exist about prophylactic removal of MG. ...
... Classification of multiple gallbladders according to Harlaftis et al., 3 including all subtypes of variation (Type 4 was initially not described) HPB 2018, 20, 985-991one.43 Two gallbladder cancers (1%) were identified in an accessory gallbladder by Kawanishi et al.8 and Kin et al.9 ...
Background:
Multiple gallbladders (MG) are a rare malformation, with no clear data on its clinical impact, therapeutic indications or risk for malignancy.
Methods:
A systematic review of all published literature between 1990 and 2017 was performed using the PRISMA guidelines.
Results:
Data of 181 patients extracted from 153 studies were reviewed. MG were diagnosed during the treatment of a gallstone-related disease in 83% of patients, of which 13% had previous cholecystectomy and had a recurrence of biliary stone disease. The sensitivity of ultrasound scan was 66%, and that of magnetic resonance imaging cholangio-pancreatography, 97%. The cystic duct was common to both gallbladders (type1) in 43% and separated (type 2) in 50% of patients. In the latter case, there was no way to differentiate preoperatively an accessory gallbladder from a Todani II bile duct cyst. Cholecystectomy was performed in 129 patients by laparotomy (43%) or laparoscopy (56%). MG was undiagnosed before surgery in 24% of the patients. The postoperative biliary leakage rate was 0.7%. In two patients, gallbladder cancers were detected.
Conclusion:
MG are difficult to diagnose and share a common natural history with single gallbladders, without evidence of increased risk for malignancy. Excision of both gallbladders is indicated in symptomatic stone disease. However, prophylactic cholecystectomy must be considered for type 2 MG, since it cannot be preoperatively differentiated from a Todani II bile duct cyst, which is associated with a risk of malignant transformation.
... Double gallbladder abnormalities are typically associated with gallstones and cholecystis, with sporadic reports of other anomalies. Kawanishi et al (18) reported a double gallbladder with an adenocarcinoma originating in the left hepatic duct. Nayak et al (17) reported a case concerning a double gallbladder completely enclosed in a cystogastric peritoneum fold. ...
A double gallbladder is a rare congenital malformation. The present study describes a case of double gallbladder with secondary common bile duct stones. By way of laparoscopic choledochoscopy,the exploration and removal of a common bile duct stone was performed through the cystic duct. The process involved a primary suture of the cystic duct and was performed without using a T‑tube,and completed a surgical removal of the gallbladder. The present case was successfully treated by laparoscopic surgery. From a review of previous studies published in the English language,this study,to the best of our knowledge,is the first report of such a case. Therefore,laparoscopic dissection is safe for the removal of a double gallbladder and for exploration of the common duct by choledochoscopy.
... Increased incidence of gallbladder diseases has not been reported with duplication or triplication. 6,9 The commonest pathology is cholelithiasis which may affect one or both lobes (or all three lobes in triplication). Reports have been published with both lobes of a double gallbladder affected by different disease entities. ...
Congenital gallbladder anomalies are rare and the only clinically silent entities. Septate gallbladder, with a reported incidence of 1 in 3800-4000, is now being reported with an increasing frequency. A 52 year old known hypertensive male presented to surgical clinic with off and on right upper quadrant pain, nausea and flatulent dyspepsia of two months’ duration. He was diagnosed with a double gallbladder on abdominal ultrasonography, with gallstones in one of the gallbladders. Subsequently, he underwent uneventful open cholecystectomy. Knowledge about the embryological origin, anatomical variation and differential diagnosis is essential from a surgeon’s point of view to avoid per-operative mishaps.
Key Words: Hour glass gallbladder, Septate gallbladder, Double gallbladder, Cholecystectomy
A very uncommon congenital defect called multi-septate gallbladder (MSG) typically results from wrinkling of the gallbladder membrane or insufficient vacuole formation of the growing bud of the gallbladder. The many septa giving MSG its honeycomb appearance cover the whole lumen of the gallbladder. MSG, hyperplastic cholecystitis, and cholecystitis are a few causes of this ultrasonography finding. A large number of patients describe having persistent stomach issues, including discomfort in the epigastrium, and frequent episodes of discomfort in the abdomen with episodes of nausea. The gallbladder's reduced motility is caused by septa, which causes a halt in the passage of bile and may be the cause of persistent stomach discomfort. The purpose of this report is to provide readers with a better knowledge of this ailment and its recommended course of treatment. We are describing a case of a MSG in a 22-year-old patient. We additionally included a few instances for evaluation and analysis. According to the research that is currently accessible, congenital MSG is most likely caused by the gallbladder wall being pushed into its cavity, creating septa that contain muscle fibers. Alternative imaging techniques like magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) are the best tools to make the diagnosis. The effectiveness of medical interventions is unknown; however, cholecystectomy has completely resolved symptoms in people.
Gall Bladder Duplication: An interesting report of laparoscopic cholecystectomy performed on two cases of Gall Bladder Duplication over one week. Introduction: Duplication of the gall bladder is very rare. Due to the unusual anatomy, laparoscopic cholecystectomy can be challenging.
A duplicate gall bladder was diagnosed at laparoscopy, having been erroneously diagnosed on ultrasonography as a dilated common bile duct with choledocholithiasis. Gallbladder duplication is a congenital abnormality with a rare incidence, occuring in approximately 1 in 4 000 births and 0.020% in al large autopsy series. This report highlights its existence to improve awareness and lessen the potential for biliary injury.
