3010 Duplicated Gallbladder: A Rare Cause of Recurrent Cholecystitis in a Hispanic Woman

Abstract

INTRODUCTION: Duplicated gallbladder (DG) is a rare congenital anomaly, affecting approximately 1 in 4000 births. Few reports exist describing acute cholecystitis in DG patients, with even less case reports of chronic cholecystitis. In this case we present a case of CC in a Hispanic woman with a DG. CASE DESCRIPTION/METHODS: A 49-year-old Hispanic woman with a history of dyslipidemia and diabetes presents to the ED with a 5-hour history of 10/10 crampy, mid-epigastric, non-radiating abdominal pain associated with subjective fevers, nausea and non-bloody, non-bilious vomiting. Patient had similar pain episodes in the past requiring hospital admissions. She was hemodynamically stable with a physical exam remarkable for moderate distress from pain and significant epigastric and right lower quadrant abdominal tenderness on palpation. Laboratory exam was significant for WBC- 12 th/uL (N: 4.8-10.9 th/uL), hemoglobin - 9.0 gm/dL (10.8-14.7 gm/dl) and ALP- 133 IU/L (N: 34-104 IU/L). Urinalysis was positive for WBC, bacteria, leukocyte esterase and nitrite. Abdominal ultrasound, CT abdomen and HIDA scan were suggestive of a DG. The patient was taken for a cholecystectomy. In the OR she was found to have a DG with 2 fundi merged at the Hartman's pouch, likened to the Boyden's vesica fellea divisa classification type. Pathology results revealed chronic cholecystitis and cholesterolosis in the DG. Patient continues to maintain significant clinical improvement post-surgery and she continues to be under close follow-up. DISCUSSION: CC is defined by the histopathologic appearance of chronic inflammation of the gallbladder and is believed to develop due to the presence of gallstones, although cases of acalulous CC also exist. As in our case, patients typically present with pain, however pain severity and liver enzyme alterations do not usually correlate with disease presence. To the best of our knowledge, no similar cases have been reported in the Hispanic population. In patients presenting to the ER, a high index of suspicion is recommended to improve overall patients' outcomes especially in patients presenting with multiple disease processes.