Dual Gallbladders with Dual Cholecystitis

Dual gallbladders, or gallbladder duplication are an uncommon entity encountered by surgeons. When problems arise, such as cholecystitis, these anomalies are uncovered during an operation. Often the problem is unknown until it is uncovered intra-operatively due to lack of pre-operative suspicion. A 26 year old female presented with signs and symptoms of acute cholecystitis. Pain had been intermittent for the prior 3 months and biliary colic was originally diagnosed. Elevated liver function test warranted preoperative imaging which showed a possible septated gallbladder and non-filling of the gallbladder consistent with cholecystitis. A decision was made to procedure with a laparoscopic cholecystectomy. Upon operative intervention dual gallbladders were encountered, both with associated inflammation. The dual gallbladders each had their own cystic duct and artery and were removed in a minimally invasive fashion. The patient did well in the peri-operative period and was discharged home without complication. Pathology was consistent with cholecystitis in both gallbladders-one of acute nature, and one consistent with chronic cholecystitis. If suspected pre-operatively, magnetic resonance cholangiopancreatography can be utilized to ascertain the presence of dual gallbladders; however, the significance of this is debated. If encountered in the setting of single gallbladder cholecystitis controversy exists as to whether the normal gallbladder should be removed. At present, the recommendation is to remove both gallbladders in order to avoid leaving behind the “symptomatic” gallbladder. This also allows the surgeon to avoid re-exploration in a previously operated field in case of persistent symptoms from recurrent cholecystitis. This case represents a rare challenge in the diagnosis and treatment of a congenital anomaly with the acquired affliction of dual cholecystitis.