"Y" in the Gall Bladder Fossa: Think of Duplicated Gall Bladder.

Abstract

A 3-year-old boy presented with epigastric pain for 8 days, vomiting and jaundice for 3 days. Ultrasonography showed 2 gall bladders communicating in the neck region with a common cystic duct (Fig. 1A). Magnetic resonance cholangiopancreatography showed 2 gall bladders in a Y-shaped configuration (Fig. 1B and C), with a single cystic duct joining the common hepatic duct. The common bile duct showed fusiform dilatation (Fig. 1C) with multiple T2 hypointense foci (Fig. 1B). A diagnosis of partially duplicated gall bladder with choledocholithiasis was offered. Duplicated gallbladder, a rare congenital anatomical variant of the hepatobiliary system, can be classified into three types according to Boyden (Vesica fellea divisa, Vesica fellea duplex Y-type and Vesica fellea duplex H-type) (1,2), and 2 types according to Harlaftis et al (Types 1 and 2) (1,3). Type 1 is further subdivided into septated, V-shaped or Y-shaped types. Our case would be classified as Vesica fellea divisa in the Boyden system and Type 1—Y shaped in the Harlaftis classification. Cholecystectomy, indicated in gall bladder duplication in symptomatic patients only (1), is planned along with common bile duct excision and hepaticojejunostomy in our patient.FIGURE 1: A--C, Ultrasound image (A) showing 2 gall bladders communicating in the region of the neck. Axial T2WI (B) and MRCP (C) images showing the duplicated gall bladder (white arrows in B and C) with fusiform dilatation of the common bile duct (black arrow in C) with hypointense filling defects (black arrow in B) suggestive of choledocholithiasis. MRCP = magnetic resonance cholangiopancreatography.