Accessory Gallbladder Research Articles

Prenatal ultrasound diagnosis of duplication gallbladder: a multicenter study.

Gallbladder duplication is a rare anatomic anomaly characterized by the presence of an accessory gallbladder. To appraise the prevalence and significance of prenatal diagnosis of duplication of gallbladder in a multicenter study. This was a multicenter case series with literature review. Clinical records of all consecutive pregnant women with a prenatal diagnosis of duplication of gallbladder, who were referred to our Centers were included in this study. The diagnosis of duplication of gallbladder was based on the evidence of double gallbladder in the standard abdominal circumference plane using grey scale. Postnatal magnetic resonance cholangiopancreatography (MRCP) 3D and postnatal neonatal abdominal ultrasound scan were offered soon after birth to confirm the diagnosis of double gallbladder. The systematic review was conducted using electronic databases from inception of each database through December 2019. Five studies, including a total of seven cases, were identified as relevant and included in the systematic review. Gestational age at diagnosis ranged from 20 to 32weeks of gestation. Associated findings were reported in only one case, where the fetus presented with a left-sided gallbladder, and bilateral renal agenesis with Potter sequence. None of the included cases reported abnormal karyotype. Our cases series included nine cases (0.03%) of double gallbladder with postnatal confirmation, with an overall incidence of this anomaly of 0.03%.Associated findings were reported in only two cases, one with IUGR and omphalocele, that opted for I-TOP, and one with single umbilical artery. Except for the I-TOP, neonatal outcome was favorable in all cases. Duplication of the gallbladder is a very rare malformation with only seven cases reported in the literature diagnosed prenatally. This anomaly is not associated with abnormal karyotype, and the neonatal outcome is favorable if there are no other associated abnormalities.

Symptomatic duplicated gall bladder – A rare presentation with a review of the literature

Gallbladder duplication is a rare congenital anomaly. Knowledge of its various types is important since it can complicate cholecystectomy. Many varieties of gall bladder duplication and its classification are reported in the literature. Pre-operative diagnosis plays a crucial role in the planning of surgery and preventing possible injuries or re-operation if the accessory gallbladder has been overlooked during the initial surgery. Gallbladder duplication though rare requires special attention to pre-operative anatomy and its variation. The operative challenge is more than the usual laparoscopic cholecystectomy and should be done by fundus first approach by an experienced laparoscopic surgeon. We report a case of a 44-year-old -male who presented with biliary colic. His pre-operative imaging confirmed the diagnosis of the duplicated gall bladder, and he underwent successful laparoscopic cholecystectomy.

A duplicated Gallbladder in a Patient Presenting with Acute Cholangitis. A Case Study and a Literature Review

Gallbladder duplication can present a clinical challenge primarily due to difficulties with diagnosis and identification. Recognition of this anomaly and its various types is important since it can complicate a gallbladder disease or a simple hepatobiliary surgical procedure. The case report of a 63-year-old woman who presented with cholangitis and underwent a successful laparoscopic management of symptomatic gallbladder duplication is described, emphasizing several important considerations. Using ERCP, MRCP and 3D reconstructions the two cystic ducts with one common bile duct were identified. A review of the literature in referral of this variant, its anatomical classifications and significance to clinical and surgical practice is included. In conclusion, gallbladder anomalies should be anticipated in the presence of a cystic lesion reported around the gallbladder when evaluating radiologic studies. In case of surgery, preoperative diagnosis is essential to prevent possible biliary injuries or reoperation if accessory gallbladder has been overlooked during initial surgery. Laparoscopic cholecystectomy remains feasible for intervention can be safely done and awareness is necessary to avoid complications or multiple procedures.

Accessory Gallbladder Complicating Liver Transplantation.

Accessory gallbladder in a donor liver allograft is an uncommon anatomical finding that can complicate liver transplantation if unrecognized. This case describes a patient who underwent liver transplantation with a donor graft containing an accessory gallbladder that was obscured during transplantation; as a result, the patient experienced a prolonged postoperative course complicated by multiple readmissions for suspected biloma and intra-abdominal infection. The diagnosis of accessory gallbladder was not made until operative exploration several months after the initial transplant. Removal of the accessory gallbladder has led to resolution of clinical problems.

Dual laparoscopic cholecystectomies for dual primordium duplicate accessory gallbladder having independent cystic duct and artery.

Dual laparoscopic cholecystectomies for dual primordium duplicate accessory gallbladder having independent cystic duct and artery.

A very original case of a mini accessory liver lobe with its own gallbladder

Anatomic variation of the hepatobiliary system is often related to the biliary tract and vascular supply of the liver. We present here one of the smallest accessory hepatobiliary system. The case of a 30-year-old male who was a living liver donor is presented. During the dissection of the portal hilum, 1.5 cm of accessory liver (AL) tissue was noted below the left lobe of the liver. This AL tissue had a gallbladder of 1.5 cm and which had a cystic duct opening to the bile duct of the accessory liver. The AL bile duct opened to the left bile duct of the liver. The arterial and portal supply of the AL came from the left artery and left portal vein of the liver. The accessory gallbladder also had a cystic artery coming from the arterial branch of the AL. It was noted that the hepatic vein of the AL opened directly to left lobe tissue. The hepatobiliary system has many anatomic variations, but this case is rare and original in the literature in that it may be a cause of confusion and even a false diagnosis.

An Adolescent Girl With Belly Pain

A 15 year old previously healthy girl presented with 3 months of right upper quadrant abdominal pain, persistent nausea, and seven kg weight loss. Her exam revealed right upper quadrant and epigastric tenderness. Laboratory investigations, including bilirubin and liver enzymes, were normal. An abdominal ultrasound revealed a contracted gallbladder and a small ovoid structure in the right upper quadrant suggesting a possible choledochal cyst. Magnetic resonance cholangiopancreatography (MRCP) better defined these lesions as a 2.8 × 2 × 2 cm “ovoid” cystic structure (small arrow in Figure 1) and a gallbladder (larger arrow Figure 1). Onendoscopic retrograde cholangiopancreatography (ERCP) both structures filled with contrast with two completely separate cystic ducts attached to the common duct (Figure 2 and online-only images available at http://links.lww.com/MPG/A94). Figure 1 Magnetic resonance cholangiopancreatography (MRCP) noted a 2.8 × 2 × 2 cm “ovoid” cystic structure (small arrow) and gallbladder (large arrow). Figure 2 ERCP shows two completely separate cystic ducts (white arrows) attached to the common bile duct as well as two distinct gallbladders. She continued to be symptomatic and subsequently had a laparoscopic cholecystectomy. The intraoperative cholangiogram confirmed the ERCP findings. Accordingly, both gallbladders were removed. Examination of the resected specimens by histology confirmed two gallbladders and entirely separate cystic ducts (see online-only images). Duplicated gallbladder is a rare anomaly of the biliary system with the reported incidence between 1 in 3800.1 The differential diagnosis for a cystic structure in the gallbladder region includes choledochal cyst, folded gallbladder, gallbladder diverticulum, focal adenomyomatosis, fibrous or vascular band and duplication of any other structure in the biliary system2. Although both ultrasound and MRCP are utilized in the evaluation of gallbladder anomalies, ERCP remains the gold standard to define this biliary tree abnormalitity3. Causey et al. recently published a similar case and contend that defining the type of gallbladder duplication (based on the Harlaftis classification4 of multiple gallbladders) will aid in the selection of operative technique5. They reason that laparoscopy can be used for type 1 (the split primordial group, sharing a single cystic duct) and a traditional open approach should be used for type 2 (accessory gallbladder arising from separate primordium with two discrete ducts)5. The consensus from multiple case reports has been to only operate on symptomatic patients and remove both gallbladders given the risk of continued symptoms and non-functionality of either structure.

Accessory gallbladder: a new anatomical variation arising from both left and right hepatic ducts

We present a case of accessory gallbladder demonstrating an anatomical variation not previously reported. While rare, accessory gallbladders are an important consideration if a cholecystectomy is to be performed. We also present a brief literature review of accessory gallbladders.

Accessory Gallbladder - An Anomaly Not Seen on Pre- or Intra-Operative Imaging

Accessory Gallbladder - An Anomaly Not Seen on Pre- or Intra-Operative Imaging

A Case of Double Gallbladder with Adenocarcinoma Arising from the Left Hepatic Duct: A Case Report and Review of the Literature

Double gallbladder is a rare congenital biliary anomaly, but an accessory gallbladder arising from the left hepatic duct is a more remarkably rare congenital anomaly. We report a case of double gallbladder with adenocarcinoma and gallstones, which was preoperatively diagnosed by endoscopic retrograde cholangiopancreatography (ERCP) and then confirmed by open laparotomy. A review of the literature is presented.

Doppelt angelegte Gallenblase – Laparoskopische Cholezystektomie 17 Jahre nach konventioneller Cholezystektomie

Duplication of the gallbladder is a rare congenital anomaly. An incidence of 2.5:10,000 has been published in autoptic studies. We carried out an analysis of the published case reports of the last 30 years to examine those cases in which an accessory gallbladder was pre- or intraoperatively detected or missed and to evaluate the implications of the time of diagnosis of the duplication on the surgical therapy. 28 case reports were analysed. If the duplication of the gallbladder was recognised pre-operatively or during operation, both gallbladders could be removed via laparoscopy in 80 % of the cases. Missing the second gallbladder can lead to persisting symptoms, postoperative complications as well as a recrudescence of the cholecystolithiasis with following reoperation. If a reoperation for a missed second gallbladder was necessary, only 14.3 % of these operations could be performed via laparoscopy. We report the case of a missed gall-bladder duplication with an acute cholecystitis causing a reoperation 17 years after the initial operation. A laparoscopic cholecystectomy was possible even though the initial operation was performed through open surgery. If recognised in preoperative examinations or during surgery a laparoscopic cholecystectomy of both gallbladders is possible in the majority of cases with duplicated gallbladder.

Accessory Splenectomy with Gastroesophageal Devascularization for Recurrent Hypersplenism and Refractory Bleeding Varices in a Patient with Liver Cirrhosis: Report of a Case

We report a case of recurrent thrombocytopenia associated with symptomatic enlargement of an accessory spleen, 2 years after splenectomy, in a 36-year-old man with posthepatitic liver cirrhosis. The patient suffered three episodes of variceal bleeding, but the esophageal varices were not eradicated by two sessions of endoscopic injection sclerotherapy and endoscopic band ligation. Abdominal ultrasonography and computed tomography showed a giant accessory spleen (6 x 6 x 5 cm), gallbladder stones, and complete postsplenectomy splenomesoportal thrombosis. Subsequent 99mTc scintigraphy confirmed the presence of a functioning residual splenic nodule. Thus, we performed gastroesophageal devascularization (Hassab-Paquet procedure) with accessory splenectomy and cholecystectomy, after which the platelet count normalized and no further variceal bleeding occurred during 17 months of follow-up. To our knowledge, this is the first report in the English medical literature of accessory splenectomy for recurrent thrombocytopenia in a patient with liver cirrhosis.

Retroperitoneoscopic nephroureterectomy of a horseshoe kidney in a child

Laparoscopic cholecystectomy is sometimes difficult due to complicated biliary anatomy including gallbladder duplication, a rare anomaly of the biliary tract. We report a case of duplicated gallbladder successfully removed under laparoscopy using endoscopic nasobiliary (ENB) tube cholangiography. A 61-year-old Japanese woman presented us with right upper abdominal pain. Ultrasonography revealed two cystic structures lying in the gallbladder fossa, and the upper one contained multiple stones. Endoscopic retrograde cholangiography showed two gallbladders, each of which has a cystic duct draining into the common bile duct separately. Laparoscopic cholecystectomy was planned under the preoperative diagnosis of double gallbladder with gallstones in the accessory gallbladder. The ENB tube was inserted just before the operation. Laparoscopic removal of the double gallbladder was successfully done using the ENB tube to identify the biliary tree anatomy and to close the stump of the cystic duct. In this communication, we would like to stress the usefulness of the ENB tube at the time of laparoscopic biliary surgery in patients with biliary anomalies including gallbladder duplication.

Accessory gallbladder originating from the right hepatic duct

A patient with symptomatic cholecystolithiasis underwent laparoscopic cholecystectomy after confirmation of the diagnosis by sonography. Intraoperative cholangiography was normal and the operation was completed laparoscopically. Due to the postoperative persistence of right upper abdominal pain, another sonogram and then an endoscopic retrograde cholangiogram (ERCP) were performed. To our surprise, an accessory gallbladder with a remaining gallstone was revealed. The accessory cystic duct was shown as arising directly from the right hepatic duct. The patient underwent a second laparoscopic cholecystectomy, but due to hemorrhaging the operation had to be converted to an open procedure. The two gallbladders and their corresponding cystic ducts and arteries were entirely separate. To our knowledge, this is the first publication of a duplicate gallbladder where the cystic duct arose directly from the right hepatic duct.

Laparoscopic Double Cholecystectomy

Gallbladder anomalies, although rarely seen, can be a challenge to the surgeon. There are many cases in the literature in which double gallbladder has been missed at the first operation. A case in which accessory gallbladder was suspected, confirmed at the operation, and managed successfully by laparoscopic cholecystectomy is described. The lack of specific symptoms and findings and the inaccuracy of imaging methods may cause missed diagnoses. The laparoscopic surgeon should always be aware of this abnormality.

Laparoscopic double cholecystectomy.

Gallbladder anomalies, although rarely seen, can be a challenge to the surgeon. There are many cases in the literature in which double gallbladder has been missed at the first operation. A case in which accessory gallbladder was suspected, confirmed at the operation, and managed successfully by laparoscopic cholecystectomy is described. The lack of specific symptoms and findings and the inaccuracy of imaging methods may cause missed diagnoses. The laparoscopic surgeon should always be aware of this abnormality.

Accessory gallbladder bed (Subvesical duct or duct of Luschka's) biliary leaks after laparoscopic cholecystectomy

Accessory gallbladder bed (Subvesical duct or duct of Luschka's) biliary leaks after laparoscopic cholecystectomy

A CASE OF DOUBLE GALLBLADDER ASSOCIATED WITH CHOLELITHIASIS

A 46-year-old woman had suffered from occasional attacks of upper abdominal pain and mild jaundice for 6 years, and had been diagnosed as hepatolithiasis with computed tomography and abdominal echography at elsewhere. On admission to the hospital endoscopic retrograde cholangiography (ERC) and percutaneous transhepatic cholangiography (PTC) revealed the double gallbladder associated with gallstones in the accessory gallbladder and with choledochal stones. It was diagnosed as double gallbladder with biliary stones (H-shaped type, Gross' classification type B). Both gallbladders were removed and a T-tube was placed in the common bile duct. The postoperative course was uneventful. The double gallbladder is a rare anomaly. Fifty-two Japanese cases of double gallbladder including this case have been seen. Correct preoperative diagnosis has been achieved in 28 (58%) of the 52 cases. The correct diagnosis rate has been increasingly improved with the progression of imaging techniques, such as 11% before 1980 to 48% after 1981. The association of gallstone was reported in 28 (61%) out of 46 cases. Except 9 cases in which no description was found about whether the stones existed in both gallbladders or not, 11 out of 19 cases had gallstones in the both gallbladder, and of the remaining 8 cases 5 had gallstone only in the accessory gallbladder like this case. Gallbladder carcinoma was found in 3 cases. These results indicate that both gallbladders should be removed.

Accessory liver with double gall bladder.

The most frequent abnormalities of the liver are irregularity in form, variation in the number of lobules, and the presence of cysts. 9 A less frequent abnormality is the occurrence of an accessory liver. Most rare is an accessory gall bladder within the accessory liver. Few such anomalies have been reported. Rogues and Solier, 11 and Hardisty, Kearney, and Brooks 6 presented individual cases in which deformity of the right diaphragm was found on routine x-ray examination of the chest. In each case an accessory lobe arising from the superior surface of the right lobe of the liver was encountered in the chest cavity at operation. Friedman, Solis-Cohen, and Levine 3 reported the same type of anomaly in a one-year-old girl and pointed out the diagnostic importance of pneumoperitoneum. A case of accessory lobe arising from the right lower lobe of the liver was reported by Fraser. 2 The significance

Two cases of accessory gall bladder in the rhesus monkey, Macaca mulatta

Two cases of accessory gall bladder in the rhesus monkey, Macaca mulatta