Multiple gallbladders

Last revised by Ismael J Nassar on 13 Jan 2024

Multiple gallbladders are a rare anatomic anomaly characterized by the presence of one or more accessory gallbladder.

Prevalence demonstrates regional variation between 1 in 50 (India) to 1 in 3800 (USA) 4.

Multiple gallbladders are typically found incidentally during the work-up of biliary disease 4.

The Harlaftis classification divides gallbladder duplication into four types 4:

  • type 1 is characterized by a common cystic duct and is due to late division of the pars cystica

    • septated gallbladder

    • septated gallbladder and cystic duct

    • V-shaped double gallbladder

    • Y-shaped double gallbladder: second most common 4

  • type 2 is characterized by double cystic ducts and is due to early division of the pars cystica or pars hepatic

    • ductular type (H-shaped): most common 4

    • right trabecular type

    • left trabecular type

    • duodenal type

  • type 3 is characterized by triple gallbladders

    • Y+Y shaped

    • Y+H shaped

    • H+H shaped

    • trabceular type

  • type 4 is characteristic by no cystic duct

    • undrained duplicated gallbladder

The Boyden classification divides gallbladder duplication into three groups 8:

  • bilobed, incomplete gallbladder division with one common cystic duct

  • complete gallbladder duplication with separate cystic ducts that lead to a common hepatic duct

  • complete gallbladder duplication with a common cystic duct entering the common hepatic duct

Classification is more easily applied today using MRCP, since ultrasound does not always allow adequate visualization of the cystic duct and ERCP is an invasive procedure requiring anesthesia 4.

There is no established increased risk of malignancy or calculi compared to a single gallbladder 4.

Imaging differential considerations include:

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Cases and figures

  • Figure 1: classification
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  •  Case 1
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  • Case 2: bilobed gall bladder
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  • Case 3
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  • Case 4
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  • Case 5
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  • Case 6
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  • Case 7
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  • Case 8
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  • Case 9
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  • Case 10
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