Laparoscopic management of gallstones in a duplicate gallbladder with double cystic ducts: A case report

Abstract

BACKGROUND

Duplicated gallbladder with two completely independent cystic ducts is an exceptionally rare congenital anomaly. This case report documents an example of successful laparoscopic management, adding to the limited literature by highlighting the importance of accurate preoperative imaging and surgical planning.

CASE SUMMARY

We present the case of a 46-year-old Uyghur woman who was admitted with intermittent right upper abdominal pain accompanied by nausea and vomiting that had persisted for 1 week. Her basic blood test results, including liver function test, were normal. Preoperative ultrasound revealed an abnormal echo in the gallbladder region, suggesting a double gallbladder malformation with one chamber containing multiple stones. Computed tomography and magnetic resonance cholangiopancreatography confirmed a double gallbladder anomaly. The patient subsequently underwent successful laparoscopic cholecystectomy. During the procedure, two gallbladder chambers were identified, with each cystic duct being independently inserted into the common bile duct. Surgery was completed without complications, and postoperative pathology confirmed the presence of gallstones and chronic cholecystitis. Because of the effective preoperative assessment, the patient recovered smoothly and was discharged 3 days after surgery, reporting no discomfort during follow-up.

CONCLUSION

This case highlights the need for thorough evaluation of rare gallbladder anomalies; literature recommends removing both to prevent disease recurrence. We present this case to raise clinical awareness, support appropriate diagnosis, and reinforce the recommendation to remove both gallbladders to prevent recurrence of gallbladder disease.

Key Words: Duplicate gallbladder; Double cystic duct; Gallstones; Laparoscopic cholecystectomy; Case report

Core Tip: Duplicated gallbladder featuring two completely independent cystic ducts is an extremely rare congenital anomaly. Herein, we present the rare case of a 46-year-old female patient with a completely independent cystic duct duplication anomaly accompanied by gallstones. Preoperative ultrasound, computed tomography, and magnetic resonance cholangiopancreatography confirmed the presence of a double gallbladder anomaly. The patient was successfully treated by laparoscopic cholecystectomy. During the procedure, two gallbladder chambers were identified, with each cystic duct being independently inserted into the common bile duct.

INTRODUCTION

Gallbladder anomalies are rare congenital malformations that can significantly affect patient health. There are various types of anomalies, including agenesis, hypoplasia, gallbladder duplication, and ectopic gallbladders. Duplicated gallbladders with double cystic ducts are rare. Among these, gallbladder duplication is particularly rare, with only a limited number of cases reported in the medical literature[1-4]. Patients with gallbladder duplication may experience symptoms, such as intermittent abdominal pain, nausea, and vomiting, which can often lead to misdiagnosis or delayed treatment. The diagnosis of this condition typically involves imaging techniques, such as ultrasound, computed tomography (CT), and magnetic resonance cholangiopancreatography (MRCP), which are essential for visualizing complex biliary anatomies and identifying any associated complications, such as cholelithiasis[5,6].

The case reported herein is that of a 46-year-old female patient who presented with a completely independent cystic duct duplication anomaly, along with the presence of gallstones. The unusual nature of this condition, coupled with the patient’s right upper quadrant pain and nausea, emphasizes the need to include gallbladder duplication in the differential diagnosis of individuals presenting with similar clinical signs. This case provides valuable insights into our current understanding of gallbladder anomalies and highlights the importance of comprehensive preoperative imaging and meticulous surgical planning to minimize complications during treatment. The patient recovered well after surgery, with no complications noted during the postoperative follow-up.

CASE PRESENTATION

Chief complaints

A 46-year-old female of Uyghur ethnicity with a medical history of fatty liver disease and inflammatory pulmonary nodules was admitted on March 12, 2025, complaining of intermittent pain in the right upper quadrant, which over the preceding week had been accompanied by nausea and vomiting.

History of present illness

The patient indicated that the pain commenced subsequent to eating greasy food, describing it as an intermittent colicky pain that radiated to her right shoulder and back.

History of past illness

She has a medical history of fatty liver disease and inflammatory pulmonary nodules.

Personal and family history

The patient had previously been well and there was no family history of the disease.

Physical examination

Physical examination revealed right upper quadrant tenderness with a positive Murphy sign, although no fever or jaundice were noted.

Laboratory examinations

The values obtained for blood tests, including a complete blood count, liver function test, bilirubin levels, and tumor markers, were all within the normal ranges.

Imaging examinations

Abdominal ultrasound revealed abnormal echogenicity in the gallbladder region, indicating the presence of a double gallbladder anomaly with multiple stones in one of the gallbladder cavities (Figure 1). A subsequent CT scan confirmed the presence of a double gallbladder, although failed to detect the accompanying gallstones (Figure 2). MRCP indicated a double gallbladder anomaly with a nodular low signal observed in one of the gallbladder cavities, which was assumed to be indicative of stones, whereas neither the common bile duct (CBD) nor hepatic bile ducts were dilated (Figure 3).

Figure 1 Abdominal ultrasound showing abnormal echoes in the region of the gallbladder, indicating a double gallbladder malformation. A and B: The B-ultrasound images at different angles and sections. The sizes of the two gallbladders are 52 mm × 26 mm and 43 mm × 21 mm respectively. The orange arrows indicate the gallbladder cavity. Multiple strong echoes with posterior acoustic shadowing are observed in one gallbladder cavity, providing evidence to indicate the presence of multiple stones.

Figure 2 Computed tomography scan showing a duplicated gallbladder. No gallstones are discernable on the tomographic images. A and B: The different layers of the computed tomography scan. The orange arrows indicate the gallbladder cavity.

Figure 3 Magnetic resonance cholangiopancreatography showing a double gallbladder anomaly, with a nodular low signal in one of the cavities, which is assumed to indicate the presence of stones. Neither the common bile duct nor the hepatic ducts are dilated. A: T2-weighted imaging coronal view; B: T2 fat-suppressed axial view. The orange arrows indicate the gallbladder cavity.

FINAL DIAGNOSIS

Having completed examinations, the patient was finally diagnosed with duplicated gallbladders characterized by two completely independent cystic ducts, and complicated by cholelithiasis and chronic cholecystitis in the chamber of one of the gallbladders.

TREATMENT

The patient underwent elective laparoscopic cholecystectomy, during which, two gallbladder cavities with independently draining cystic ducts were identified and successfully resected (Figure 4). Multiple gallstones were identified in one of the cavities, and both gallbladders were carefully separated and removed to prevent future recurrence.

Figure 4  Intraoperative findings showing a double gallbladder malformation, with each cystic duct independently draining into the common bile duct.

OUTCOME AND FOLLOW-UP

The patient recovered without complications, and was discharged on postoperative day 3 and reported no discomfort during subsequent follow-up. Postoperative pathology confirmed gallstones and chronic cholecystitis, and imaging and clinical follow-up revealed no recurrence of symptoms.

DISCUSSION

Anatomical variations of the gallbladder and its associated ducts have been recorded since 1926, as noted by Boyden. Among such anomalies, gallbladder duplication is a rare congenital defect, with an incidence of approximately 1 in 4000 individuals, and is almost twice as prevalent in females as in males[7,8]. According to the Harlaftis Classification, duplicate gallbladders can be categorized into three distinct types. Type I is characterized by a double gallbladder discharging into the CBD through a single cystic duct. Type II is defined as the presence of two individual cystic ducts that drain into the CBD. Finally, type III involves a gallbladder that is partitioned and possesses duplicated cystic ducts or a triplet gallbladder configuration[9]. On the basis of the preoperative examination results and intraoperative findings, the double gallbladder described herein was identified as a type II accessory gallbladder with “H” duplication.

This case is noteworthy with respect to the rarity of completely independent duplicated gallbladder anomalies, particularly in a 46-year-old female patient of Uyghur ethnicity. Moreover, case further highlights the challenges involved in diagnosing and managing such anatomical variations, which can frequently result in misdiagnoses or delays in treatment. The patient experienced intermittent right upper abdominal pain, nausea, and vomiting after consuming fatty foods, which are typical responses indicative of gallbladder-related issues. However, the presence of duplicated anomalies complicates the clinical situation, making accurate diagnosis and effective management difficult. Although in this regard, ultrasound is proficient in identifying gallbladder pathology, it may not adequately reveal anatomical variations. Accordingly, compared with ultrasound imaging, the detection of double gallbladders and other atypical biliary anatomical structures can be more effectively achieved by performing MRCP.

The current literature indicates that duplicated gallbladder anomalies can manifest in a diverse range of forms, with symptoms that may mimic typical gallbladder diseases, such as gallstones or cholecystitis. In the present case, imaging studies based in ultrasonography, CT, and MRCP, revealed the presence of multiple gallstones within one of the gallbladder cavities, whereas the other cavity remained asymptomatic. Previous studies have documented similar findings in which anatomical variations complicate the diagnosis of gallbladder diseases, leading to the potential failure to undertake the requisite surgical interventions[10].

The decision to perform laparoscopic exploration in this case was not only appropriate but also vital. This approach enabled direct visualization of the duplicated gallbladder structure, thereby facilitating the safe removal of stones while maintaining the integrity of the biliary system. Given that conservative management often fails to relieve symptoms or prevent complications, surgical intervention is frequently the definitive treatment for symptomatic gallbladder anomalies. Moreover, pathological results, which can confirm chronic cholecystitis and the presence of gallstones, highlights the importance of surgical treatment in such situations[11].

In this case, the patient’s postoperative recovery was uneventful, and no complications were reported during the subsequent follow-up, which is consistent with existing literature indicating positive outcomes in surgically managed cases. Nevertheless, given the uncommon nature of the anatomical variations involved, it is essential to maintain long-term follow-up to monitor for any potential complications that could develop later. These include the recurrence of stones or biliary obstruction stemming from anatomical anomalies, which may not have been resolved during the initial surgical intervention[12].

CONCLUSION

Our findings regarding this case highlight the importance of identifying duplicate gallbladder anomalies in patients presenting with symptoms associated with the gallbladder. Such awareness can enable clinicians to make informed decisions with respect diagnostic imaging and surgical management, ultimately contributing to an improvement in patient outcomes. This case serves as an important reminder of the potential complexities associated with the biliary anatomy and the need for a thorough preoperative investigation, particularly in patients with atypical presentations[13].

ACKNOWLEDGEMENTS

We would like to express our sincere gratitude to all authors for their invaluable contributions to this manuscript.