S1409 A Rare Case of Symptomatic Multiseptate Gallbladder in a Young Female

Abstract

INTRODUCTION: Multiseptate gallbladder is a rare congenital anomaly. Usually, these cases are incidentally found during surgery or imaging. We present the case of a young female patient who had intermittent epigastric pain and was found to have a septated gallbladder for which she ultimately required cholecystectomy to get symptomatic relief. CASE DESCRIPTION/METHODS: A 19 year old female with no prior medical history, presented with intermittent postprandial epigastric abdominal pain for 6 months. The pain would begin soon after meal intake, would be moderately severe and continue for the next 2–3 hours. No specific foods patterns were noted as a trigger. She tried to treat the pain with calcium based antacid tablets to attempt to alleviate her pain, but these did not offer any relief. Her pain was also associated with nausea but no other gastrointestinal symptoms were present. Family history was significant for symptomatic cholelithiasis in the patient’s sister requiring cholecystectomy. Social history was positive for active cigarette use. There was mild right upper quadrant tenderness on palpation during physical exam. Labs revealed a mildly elevated total bilirubin of 1.57 mg/dL while other LFTs, electrolytes, renal function and CBC were within normal limits. Urine pregnancy test was negative. An abdominal ultrasound revealed a gallbladder with multiple septations (Image 1) and hepatic steatosis. She underwent esophagogastroduodenoscopy which was normal and biopsies of her stomach and small bowel were also normal. The pain continued despite conservative management and so subsequently she had laparoscopic cholecystectomy which resulted in cessation of her pain during follow up clinic visit a few weeks after her surgery. The gallbladder tissue was sent for pathological evaluation, which showed mild chronic cholecystitis (Image 2). DISCUSSION: To our knowledge, multiseptate gallbladder has been rarely reported in the literature and chronic cholecystitis is not a common etiology. Symptoms usually occur due to transient impaired emptying of bile from the gallbladder. Some patients have had co-existing pancreatic and biliary duct abnormalities as well as gallbladder or bile duct cancer. Most of the cases were symptomatic and required therapy. Treatment options include conservative measures such as intake of a modified diet or treatment with ursodeoxycholic acid which have limited benefit and patients usually ultimately require cholecystectomy as definitive treatment.Figure 1.: US abdomen showing multiple septations in the gallbladder. No thickening of gallbladder wall or pericholecystolic fluid seen.Figure 2.: & E stain (10X) showing mild chronic cholecystitis with lymphocytic inflammation within the lamina propria (red arrows) and muscularis (blue arrows). Fibrosis and metaplastic changes are absent.