Published online Dec 27, 2015. doi: 10.4240/wjgs.v7.i12.398
Peer-review started: July 3, 2015
First decision: August 4, 2015
Revised: August 25, 2015
Accepted: October 23, 2015
Article in press: October 27, 2015
Published online: December 27, 2015
Accessory gallbladder is a rare congenital anomaly occurring in 1 in 4000 births, that is not associated with any specific symptoms. Usually this cannot be diagnosed on ultrasonography and hence they are usually not diagnosed preoperatively. Removal of the accessory gallbladder is necessary to avoid recurrence of symptoms. H-type accessory gallbladder is a rare anomaly. Once identified intra-operatively during laparoscopic cholecystectomy, the surgery is usually converted to open. By using the main gallbladder for liver traction and doing a dome down technique for the accessory gallbladder, we were able to perform the double cholecystectomy with intra-operative cholangiogram laparoscopically. Laparoscopic cholecystectomy was performed in 27-year-old male for biliary colic. Prior imaging with computer tomography-scan and ultrasound did not show a duplicated gallbladder. Intraoperatively after ligation of cystic artery and duct an additional structure was seen on its medial aspect. Intraoperative cholangiogram confirmed the patency of intra-hepatic and extra-hepatic biliary ducts. Subsequent dissection around this structure revealed a second gallbladder with cystic duct (H-type). Pathological analysis confirmed the presence of two gallbladders with features of chronic cholecystitis. It is important to use cholangiogram to identify structural anomalies and avoid complications.
Core tip: Accessory gallbladders are a rare anatomic anomaly, that classically goes unnoticed. These are often not diagnosed preoperatively in patients undergoing cholecystectomy. We present a 27-year-old male scheduled for gallbladder removal for biliary colic. Intraoperatively, following ligation of cystic artery and duct, an additional structure was noted, and intraoperative cholangiogram confirmed a second gallbladder with an associated accessory cystic duct. Pathological analysis confirmed the presence of two gallbladders with features of chronic cholecystitis. Recognizing and understanding the presentation of accessory gallbladders can prevent the pitfalls of surgery with anatomical abnormalities, as well as offering the appropriate management.