Multiple gallbladders
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View Bruno Di Muzio's current disclosuresAt the time the article was last revised Bruno Di Muzio had no financial relationships to ineligible companies to disclose.
View Bruno Di Muzio's current disclosures- Double gallbladder
- Duplication of gallbladder
- Duplication of the gallbladder
- Duplicated gallbladder
- Gallbladder triplication
- Multiple gallbladders
- Triplicated gallbladder
- Triple gallbladder
- Accessory gallbladder
Multiple gallbladders are a rare anatomic anomaly characterized by the presence of one or more accessory gallbladder.
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Epidemiology
Prevalence demonstrates regional variation between 1 in 50 (India) to 1 in 3800 (USA) 4.
Clinical presentation
Multiple gallbladders are typically found incidentally during the work-up of biliary disease 4.
Classification
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
Radiographic features
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.
Treatment and Prognosis
There is no established increased risk of malignancy or calculi compared to a single gallbladder 4.
Differential diagnosis
Imaging differential considerations include:
choledocal cyst: type 2 duplicated gallbladders cannot be pre-operatively differentiated from Todani type II cysts 4
focal region of pericholecystic fluid
focal adenomyomatosis
intraperitoneal fibrous bands (Ladd bands)
dilated cystic duct remnant
References
- 1. Mazziotti S, Minutoli F, Blandino A, Vinci S, Salamone I, Gaeta M. Gallbladder Duplication: MR Cholangiography Demonstration. Abdom Imaging. 2001;26(3):287-9. doi:10.1007/s002610000157
- 2. Desolneux G, Mucci S, Lebigot J, Arnaud J, Hamy A. Duplication of the Gallbladder. A Case Report. Gastroenterol Res Pract. 2009;2009:1-3. doi:10.1155/2009/483473 - Pubmed
- 3. Hassan Arif S, Hussein I, Mohammed A. Duplicated Gall Bladder with Gall Bladder Polyp Presenting with Cholecystitis: Case Report with Literature Review. Int J Surg Case Rep. 2019;60:103-5. doi:10.1016/j.ijscr.2019.06.002 - Pubmed
- 4. Darnis B, Mohkam K, Cauchy F et al. A Systematic Review of the Anatomical Findings of Multiple Gallbladders. HPB (Oxford). 2018;20(11):985-91. doi:10.1016/j.hpb.2018.04.002 - Pubmed
- 5. Ross R & Sachs M. Triplication of the Gallbladder. AJR Am J Roentgenol. 1968;104(3):656-61. doi:10.2214/ajr.104.3.656 - Pubmed
- 6. Ernest E. Lack. Pathology of the Pancreas, Gallbladder, Extrahepatic Biliary Tract, and Ampullary Region. (2003) ISBN: 9780199771745 - Google Books
- 7. Jon W. Meilstrup, M.D.. Imaging Atlas of the Normal Gallbladder and Its Variants. (1994) ISBN: 9780849347887 - Google Books
- 8. Boyden E. The Accessory Gall‐bladder– an Embryological and Comparative Study of Aberrant Biliary Vesicles Occurring in Man and the Domestic Mammals. Am J Anat. 1926;38(2):177-231. doi:10.1002/aja.1000380202
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- Gallbladder duplication
- Gallbladder duplication
- Gallbladder duplication
- Gallbladder duplication
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- Gallbladder duplication
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