GI Radiography


Case 11 :
An 18-year-old lady presents with generalized abdominal pain. USG is performed. What is the diagnosis? What do the labels 1 & 2 represent?

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Imaging Findings
Images reveal duplication of the gall bladder with a functioning and non-functioning component. CBD was normal in position and its size was within normal limits.

Discussion
Cases have been recorded in which there were two distinct gallbladders, each having a cystic duct that joined the hepatic duct. The cystic duct may itself be doubled. Doubled gallbladders have been found in 5 of 19,000 (0.026%) patients.

Gallbladder duplication is a well-known entity with an incidence at autopsy reported of 2.5:10,000. Boyden's classic description defines gallbladder duplication as an embryologic abnormality in biliary tract development resulting in two separate gallbladder cavities, each with a cystic duct.

The gallbladder has been found on the left side (to the left of the ligamentum teres) in subjects in whom there was no general tranposition of the thoracic and abdominal viscera.

The gallbladder may be intrahepatic or beneath the left lobe. Ectopic sites include retrohepatic positions, or in the anterior abdominal wall or falciform ligament, they may be suprahepatic or transversely position, floating, or retroperitoneal. They may be in the midline anterior epigastric above the left lobe or suprahepatic above the right hepatic lobe.

Several anomalies have been associated with gallbladder duplication including forgut malformations and aberrant hepatic and mesenteric vessels.

The right and left divisions of the hepatic duct sometimes continue separately for some distance within the lesser omentum. The common bile duct may open separately from the pancreatic duct into the duodenum. There may be one or two distinct duodenal papillae. Anomalous pancreatic tissue is occasionally found in the wall of the gallbladder.

Differential diagnosis of gallbladder duplication:
Gallbladder folds, Choledochal cyst, Gallbladder diverticulum, Hepatic cyst, Mesenteric cyst

References:
The Fetus: Gall Bladder Duplication: Antenatal Cases

Contribution:
Dr. Ravi Kadasne, UAE