Successful Laparoscopic Cholecystectomy of Double Gallbladder with Double Cholecystitis and Gallstones: A Case Report

Abstract

Gallbladder (GB) duplication is a rare congenital anomaly with various anatomical presentation. Preoperative diagnosis of this condition is not common as it is available in only 50% of cases. When problems arise, such as cholecystitis, this anomalies are exposed during an operation. We report the case of a double GB which was diagnosed during the operative procedure in fifty-seven years old woman with sign and symptom of acute cholecystitis. The liver function tests were elevated and ultrasonography showed the lithiasic cholecystitis in GB which rolled around itself. Magnetic Resonance cholangio pancreatography (MRCP) confirmed the cholecystitis on GB and revealed normal common bile duct(CBD). A decision was made to procedure with a laparoscopic cholecystectomy. Inoperative double gallbladder and double cystic duct was observed. Cholangiography was made to identify the biliary tree. A challenging laparoscopic cholecystectomy was performed successfully and pathology confirmed double H-type GB and cholecystitis on both of them. The patient was discharged home uneventfully. GB duplication has an incidence of approximately 1:4000. It can be classified as a type-I anomaly(partially split primordial gallbladder), a type II anomaly(two separate gallbladders, each with their own cystic duct) or a type III anomaly(triple gallbladders draining by 1-3 separate cystic duct). Such anatomical variations of the GB are associated with an increased risk of operative difficulty and complications including conversion to open cholecystectomy and common bile duct injury. Preoperative diagnosis of duplicate GB is difficult. This condition could not be detected preoperatively by imaging methods. During surgery, if surgeon suspects the presence of more then one cystic duct, intraoperative cholangiography is highly recommended to identify the biliary anatomy.