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ABDOMINAL IMAGING Table of Contents   
Year : 2002  |  Volume : 12  |  Issue : 2  |  Page : 231-232
Double gallbladder and accessory hepatic duct-a case report


Department of Radio-diagnosis and Imaging, Govt. Medical College, Amritsar, India

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Keywords: Gall bladder anomaly, accessory hepatic duct

How to cite this article:
Singh G, Bhandari R K, Saini D S. Double gallbladder and accessory hepatic duct-a case report. Indian J Radiol Imaging 2002;12:231-2

How to cite this URL:
Singh G, Bhandari R K, Saini D S. Double gallbladder and accessory hepatic duct-a case report. Indian J Radiol Imaging [serial online] 2002 [cited 2019 Nov 22];12:231-2. Available from: http://www.ijri.org/text.asp?2002/12/2/231/28452

   Introduction Top


Congenital anomalies of extra-hepatic biliary system are important in clinical practice because they may cause some clinical, surgical and diagnostic problems [1]. Double gallbladder, an uncommon but potentially complicating malformation is rarely diagnosed preoperatively. An accessory right hepatic duct is another rare entity. A case having both these anomalies in which diagnosis was achieved by post-operative T-tube cholangiography is presented.


   Case Report Top


A forty year old man who presented with acute right upper quadrant pain was diagnosed as a patient of acute cholecystitis with cholelithiasis on US. Surgery was performed and the gallbladder containing stones was removed. While doing surgery, it was found that local anatomy was not normal but distorted and there were massive adhesions and inflammation. A bile filled dilated structure was seen in Callot's triangle and presuming it to be dilated CBD, it was explored. No stone was detected in it. So after flushing, a T-tube was placed in it. After one week, patient was referred to Radiodiagnosis deptt. for T-tube cholangiography. The findings on T-tube cholangiography were that the patient was having another gallbladder in which T-tube was lying. It was arising from the common hepatic duct near its origin [Figure - 1]aandb. There was also an accessory hepatic duct draining the anterior segment of the right lobe of liver and joining the CBD quite lower down


   Discussion Top


Several anomalies of gallbladder may occur [2] [Figure - 2] such as;

  1. Congenital absence of gallbladder, an extremely rare anomaly
  2. Gallbladder may be septated, transversly or longitudinally
  3. Double gallbladder with single cystic duct.
  4. Double gallbladder with separate cystic ducts opening into hepatic or common or both ducts.
  5. Small hepato-cystic ducts that connect gallbladder with liver.


Variations in the bile ducts are;

  1. Frequently, common hepatic and cystic ducts lie parallel being joined by connective tissue for some distance before becoming one duct.
  2. Union of cystic and common hepatic duct is frequently behind duodenum or the pancreas and may only occur just before the duct pierces the wall of the duodenum.
  3. Usually the cystic duct joins the common hepatic duct on its right side. It may however join the duct in front, back or even the left side of the common hepatic by taking a spiral course behind it.
  4. An accessory right hepatic duct which leaves the extremity of porta hepatis and joins the common hepatic duct anywhere between the site of its formation and the entrance of the cystic duct into the common duct.
  5. Cystic duct may be absent, with the common hepatic duct entering the gall bladder and common bile duct leaving it.


In diagnostic imaging, developmental anomalies of gallbladder are usually an incidental finding. Duplication anomalies are quite rare and are characterized by a large variety of configuration depending upon the size and degree of fusion of the two lobes and on the number and disposition of the cystic ducts. [3].

Duplication of gallbladder can be classified into two types; bilobed gallbladder (Vesica fellea divisum) where a longitudinal septum or invaginating cleft separates the lumen into two chambers; and double gallbladder (Vesica fellea duplex), where there are two separate gallbladders with their own cystic ducts.

Either one or both lobes of gallbladder may be diseased [4]. A more specific sign of gallbladder duplication may be the contraction of the non-diseased lobe [5]. In the case reported here, T-tube cholangiogram was done in fasting as well as in the postprandial state. A decrease in size of gall bladder was seen very clearly in the postprandial cholangiogram, which confirmed the presence of double gall bladder.

The second anomaly seen in the present case was accessory hepatic duct. The anterior ramus of Right Hepatic duct did not join the posterior ramus but continued as a separate branch so as to join the common bile duct at an inferior level. Absence of convergence of the posterior and anterior rami of the Right Hepatic duct was found in 30% of cases [6].

Awareness of congenital extra-hepatic biliary variants may help in recognizing and correctly classifying gallbladder and other biliary abnormalities, thus preventing misdiagnosis. Emphasis is placed on the use of a complete cholangiographic evaluation before proceeding for surgery in order to prevent inadvertant damage to the biliary ductal system.

 
   References Top

1.Ozgen A, Akata D, Arat A, Demirkazik FB, Ozmen MN, Akhan O. Gallbladder duplication: imaging findings and differential considerations. Abdom Imaging 1999 May-June; 24(3): 285-8.  Back to cited text no. 1    
2.McGregor AL, Plessis DJD. A synopsis of surgical anatomy, Tenth ed. Bombay: K. M. Varghese Company, 1969: 84-88.  Back to cited text no. 2    
3.Martinoli C, Derchi LE, Pastorino C, Cittadini G Jr. Case report: imaging of a bilobed gall bladder. Br J Radiol 1993 Aug; 66 (788): 734-6.  Back to cited text no. 3    
4.Gautam A, Kala S, Kumar M, Sharma CL. Indian J Gastroenterol 1999 Oct-Nov; 18 (4): 179.  Back to cited text no. 4    
5.Goiney RC, Schoenecker SA, Cyr Dr, Shuman WP, Peters MJ, Cooperberg PL. Sonography of gallbladder duplication and differential considerations. AJR 1985Aug; 145(s): 241-3.  Back to cited text no. 5    
6.Heloury Y, Leborgne J, Rogez JM et al . Radiological anatomy of the bile ducts based on intraoperative investigation in 250 cases. Anat Clin 1985; 7(2): 93-102.  Back to cited text no. 6    

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Correspondence Address:
G Singh
H.No. 44, Gali No.3, Hukum Singh Road, Amritsar (Punjab)-143001
India
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    Figures

[Figure - 1], [Figure - 2]

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    Introduction
    Case Report
    Discussion
    References
    Article Figures

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