DOUBLE GALLBLADER. COMMON DISEASE, NOT SO COMMON PRESENTATION drenriquejean@gmail.com

317-04

DOUBLE GALLBLADER. COMMON DISEASE, NOT SO COMMON PRESENTATION

3

Mexico

Video

Gallbladder duplication is a rare congenital malformation, with an estimated incidence of 1 in 4,000-5000. Harlaftis’ classification divides it into two types: type 1, which is a split primordium with a single cystic duct: and type 2, which involves an accessory gallbladder and multiple cystic ducts. Among type 2, H-type (two gallbladders, each with an independent cystic duct draining into the common bile duct) is the most common. Magnetic resonance cholangiopancreatography (MRCP) is the most sensitive diagnostic method.

A 37-year-old woman presented to the emergency room with right upper quadrant abdominal pain radiating to the ipsilateral shoulder. She reported nausea, had tenderness on palpation and a positive Murphy's sign. Laboratory tests showed mild leukocytosis with other values within normal limits. Abdominal ultrasound revealed a double gallbladder with signs of acute cholecystitis. MRCP confirmed H-type duplication. Laparoscopic cholecystectomy was indicated.

Indocyanine green was administered preoperatively. During Calot's triangle dissection, two cystic ducts and one cystic artery were identified. Indocyanine green confirmed the anatomy. A cholangiography was performed on both cystic ducts confirming independent drainage into the common bile duct. Clips were placed on both cystic ducts and the artery followed by their transection. Both gallbladders were successfully dissected from the liver and extracted without complications.

Duplicated gallbladder is an uncommon anatomical variant. Assertive preoperative identification allows a proper surgical planning and safe approach. Complete resection of both gallbladders prevents recurrence or future complications. While laparoscopic cholecystectomy is effective, conversion to open surgery may be necessary in some cases.

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