Bilobed Gall Bladder (Vesica Fellea Divisa)

Abstract

Anomalies of the gall bladder in the human being are rare. We are indebted to Boyden (1), who has made an extensive study of the gall bladder in both animals and man. Recently Gross (2) published a very comprehensive article listing six cases of bilobed gall bladder which he was able to find in the literature, only one of which was diagnosed by cholecystography. An additional case that was recognized by the above procedure and confirmed at operation is submitted. The roentgenologist should be familiar with these malformations in order that an unusual shadow of the gall bladder may be correctly interpreted. With the increasing use of cholecystography, it is probable that these anomalies will be found with greater frequency. Boyden found cats had bilobed gall bladders in about 10 per cent of the total number he examined. Embryologically, a bilobed fundus is explained as follows: The single bud becomes paired, but a primary connection is maintained, thus forming two separate and distinct fundi with a single cystic duct. In two of the previously reported cases, the external appearance of the gall bladder showed quite a longitudinal septum. In the others and our own case, there are two separate cavities. The clinical evidence is not characteristic of an anomaly. Case History Female patient, aged 37 years, complained of a pain in the abdomen, with no particular relation to type of food or time of eating. There was no history of vomiting, or jaundice. She had lost about thirteen pounds in weight in six months' time. Physical examination was normal, except for tenderness on palpation of the abdomen, particularly on the right side. The pam seemed to radiate equally in all directions. Blood count was within normal limits. Gastric analysis at the end of fifty minutes gave 25º free hydrochloric and a total acidity of 45º. Occult blood, lactic acid, and microscopic examinations were negative. Roentgenoscopic and radiographic examinations of the gastro-intestinal tract revealed no abnormalities. A plain film of the gall-bladder area showed no demonstrable pathology. The gall-bladder dye was given intravenously, radiographic observation being made at four and six hours and one hour after a fat meal. The interpretation of the films was as follows: “Th.e gall-bladder shadow can be definitely outlined four hours after the intravenous administration of the gall-bladder dye. The gall bladder appears to be divided into two parts. This is further visible at the end of six hours. One hour after the fat meal, this division of the gall-bladder shadow can be more clearly outlined, the gall bladder having emptied itself over 80 per cent. The diagnosis arrived at is bilobed gall bladder.” At operation a bilobed gall bladder, with one cystic duct, was found. A partial cholecystectomy was done. The appendix was removed.