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Schuelke S, Kapil A, Frontela O, Angly S, Abdelmoneim SS. Imaging and Multidisciplinary Management of Acute Cholecystitis With Choledocholithiasis in a Phrygian Cap Gallbladder: A Case Report. Cureus 2025; 17:e81080. [PMID: 40271307 PMCID: PMC12017295 DOI: 10.7759/cureus.81080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2025] [Accepted: 03/24/2025] [Indexed: 04/25/2025] Open
Abstract
Anatomical variations in the gallbladder, such as a Phrygian cap, can complicate the diagnosis of acute cholecystitis, particularly when associated with choledocholithiasis. We report the case of a 43-year-old female who presented with complaints of right upper quadrant (RUQ) pain, which began one week prior and worsened over two days. The pain was associated with fever, nausea, and two episodes of vomiting the previous night. On admission, blood pressure was 104/66 mmHg, heart rate 61 bpm, respirations 18 bpm, saturating at 96%, pain 6, afebrile. The physical exam showed remarkable RUQ tenderness. Labs on admission were unremarkable apart from abnormal liver function testing (mild elevation of alkaline phosphatase (ALKP) 171 IU/L, alanine aminotransferase (ALT) 72 IU/L, and aspartate aminotransferase (AST) 48 IU/L. Ultrasound showed common bile duct dilation of approximately 11 mm without evidence of radiopaque choledocholithiasis. Sagittal computed tomography (CT) showed a distended and folded gallbladder, illustrating the anatomical variation of the Phrygian cap. Magnetic resonance cholangiopancreatography (MRCP) showed features suggestive of acute calculous cholecystitis and common bile duct filling defect consistent with choledocholithiasis. Hepatobiliary iminodiacetic acid (HIDA) scintigraphy provided evidence of acute cholecystitis and cystic duct obstruction. The patient was successfully treated with endoscopic retrograde cholangiopancreatography (ERCP), followed by a same-day laparoscopic cholecystectomy. Following three days of observation, the patient showed normal vital signs with decreasing epigastric pain. Additionally, lipase and amylase levels decreased from 366 and 1,440 U/L, respectively, to 176 and 100 U/L following ERCP. The patient was discharged home on Day 7 with acetaminophen, omeprazole, and instructions to follow up as an outpatient with both her primary and general surgery within 14 days. This case underscores the critical importance of a stepwise and multidisciplinary approach in the management of a complex case of acute cholecystitis.
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Affiliation(s)
- Sophie Schuelke
- Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Ambika Kapil
- Osteopathic Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, USA
| | - Odalys Frontela
- Internal Medicine, Palm Springs Campus, Larkin Community Hospital, Miami, USA
| | - Sohair Angly
- Internal Medicine, Larkin Community Hospital, Miami, USA
| | - Sahar S Abdelmoneim
- General Internal Medicine, Larkin Community Hospital, Hialeah, USA
- General Internal Medicine/Cardiovascular Medicine, Assiut University Hospital, Assiut, EGY
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de Paula Reis Guimarães V, Miranda J, Tamura Sttefano Guimarães C, Leão Filho H, Blasbalg R, Lahan-Martins D, Velloni FG. A comprehensive exploration of gallbladder health: from common to rare imaging findings. Abdom Radiol (NY) 2025; 50:131-151. [PMID: 38953999 DOI: 10.1007/s00261-024-04431-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/28/2024] [Accepted: 05/30/2024] [Indexed: 07/04/2024]
Abstract
This comprehensive review explores a wide range of imaging findings associated with the gallbladder (GB), from anatomic variants to rare diseases. Through an in-depth review of diagnostic modalities including ultrasound, magnetic resonance cholangiopancreatography, CT, and MRI, we aim to highlight the crucial role of imaging techniques in diagnosing GB disorders, as congenital anomalies, inflammatory diseases, neoplasms, and surgical complications. Employing a detailed analysis and comparison of imaging findings across various modalities, this review seeks to improve diagnostic accuracy for GB-related pathologies, facilitating optimal patient management.
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Affiliation(s)
- Vivianne de Paula Reis Guimarães
- Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, São Paulo, SP, 06455-010, Brazil.
| | - Joao Miranda
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
- Department of Radiology, University of São Paulo, R. Dr. Ovídio Pires de Campos, 75 - Cerqueira César, São Paulo, SP, 05403-010, Brazil
| | - Cássia Tamura Sttefano Guimarães
- Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, São Paulo, SP, 06455-010, Brazil
| | - Hilton Leão Filho
- Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, São Paulo, SP, 06455-010, Brazil
| | - Roberto Blasbalg
- Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, São Paulo, SP, 06455-010, Brazil
| | - Daniel Lahan-Martins
- Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, São Paulo, SP, 06455-010, Brazil
- Department of Radiology, Faculty of Medical Sciences, State University of Campinas (FCM-UNICAMP), R. Tessália Vieira de Camargo, 126-Cidade Universitária, Campinas, SP, 13083-887, Brazil
| | - Fernanda Garozzo Velloni
- Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, São Paulo, SP, 06455-010, Brazil
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Sepulveda W, Ranzini AC. Fetal "Phrygian Cap" Gallbladder: Malformation or Deformation? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:617-620. [PMID: 38029359 DOI: 10.1002/jum.16382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023]
Abstract
A series of five fetuses with a Phrygian cap gallbladder, a condition infrequently reported in the antenatal period, is reported. In all cases, examination of the fetal gallbladder displayed the characteristic folding of the fundus over the body. No associated findings were detected. The gallbladder length was longer than normal in all cases, suggesting that this anomaly could represent a deformity rather than a primary malformation. This might be caused by excessive longitudinal growth of the gallbladder, eventually folding after the fundus reaches the anterior border of the liver and is then diverted laterally by the abdominal wall.
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Affiliation(s)
- Waldo Sepulveda
- Fetal Imaging Unit, FETALMED-Maternal-Fetal Diagnostic Center, Santiago, Chile
| | - Angela C Ranzini
- Department of Obstetrics and Gynecology, The MetroHealth System/Case Western Reserve University, Cleveland, Ohio, USA
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Spain HN, Penninck DG, Thelen M. Ultrasonographic prevalence and proposed morphologic classification of bilobed gallbladder in cats. J Feline Med Surg 2022; 24:986-993. [PMID: 34709081 PMCID: PMC10812300 DOI: 10.1177/1098612x211055629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Morphologic anomalies of the feline gallbladder (GB) have been previously reported in the literature. These morphologic variants are frequently encountered on routine abdominal ultrasound examination. The aim of this study was to provide an ultrasonographic classification system of these variants and document the overall incidence in the feline population. METHODS A prospective, descriptive study was undertaken; cats that had an abdominal ultrasound examination that included at least one sagittal and transverse plane image of the GB were included. GB shape was evaluated and categorized based on a classification scheme of morphologic variants modified from the human literature. Septated (S), bilobed (B1, B2, B3), duplex (D) and complex (C) categories were described. RESULTS Of 516 cats included in the study, 389 had normal GB morphology, while 127 had anomalous GB morphology. The overall incidence rate of anomalous GB morphology was 24.61%. When examined by morphologic type, the septated (S) morphology had an incidence of 9.69%. A bilobed (B) morphology was the most commonly observed classification; incidence was 14.35% within our population; incidence of B1, B2 and B3 subtypes were 2.91%, 6.98% and 4.46%, respectively. Duplex GBs only made up 0.39% of the total population. The incidence of complex (C) morphologies was 0.19%. CONCLUSIONS AND RELEVANCE The incidence of GB morphologic anomalies was higher in our population than previously reported. Identification of these anomalies on routine ultrasound evaluation is common; numerous different morphologies can be identified and a standardized classification scheme is proposed. Complete evaluation of morphology can be challenging, particularly with regard to cystic duct anatomy. Clinical significance is uncertain and future studies are warranted to determine the relationship between morphologic variants and hepatobiliary disease.
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Affiliation(s)
- Heather N Spain
- Department of Radiology, BluePearl, The Pet Specialists of Monterey, Del Rey Oaks, CA, USA
| | - Dominique G Penninck
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, USA
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Farney M, Verplancken E, Winton EB. Man with Right Upper Quadrant Abdominal Pain. Ann Emerg Med 2021; 78:e91-e92. [PMID: 34802600 DOI: 10.1016/j.annemergmed.2021.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Michael Farney
- Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC
| | - Evan Verplancken
- Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC
| | - Elizabeth B Winton
- Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC.
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Badrawi N, Iqbal SS, Ahmed A, Albastaki U. Intrahepatic gallbladder mimicking a cystic liver lesion: A case report & literature review. Radiol Case Rep 2021; 16:2746-2748. [PMID: 34377223 PMCID: PMC8327496 DOI: 10.1016/j.radcr.2021.06.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 12/24/2022] Open
Abstract
Intrahepatic gallbladder is a rare congenital variant that occurs due to migration arrest of the gallbladder from reaching its normal position. We present a case of a 60year-old gentleman presenting with chronic abdominal pain and impaired liver enzymes. Abdominal ultrasonography showed a hepatic cystic lesion which later was identified as an ectopic gallbladder within the liver parenchyma through magnetic resonance imaging study of the liver. Although ectopic gallbladder is a rare anomaly, awareness and correct identification of the abnormality prevents misdiagnosis with other liver pathologies as it may mimic other pathologies as presented in this case. It also allows better operative planning when indicated.
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Carlson CL, Boehnke MW, Paltiel HJ. Gallbladder and Biliary Tract. PEDIATRIC ULTRASOUND 2021:433-479. [DOI: 10.1007/978-3-030-56802-3_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Wang HH, Portincasa P, Liu M, Tso P, Wang DQH. An Update on the Lithogenic Mechanisms of Cholecystokinin a Receptor (CCKAR), an Important Gallstone Gene for Lith13. Genes (Basel) 2020; 11:1438. [PMID: 33260332 PMCID: PMC7761502 DOI: 10.3390/genes11121438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 11/23/2020] [Accepted: 11/27/2020] [Indexed: 12/15/2022] Open
Abstract
The cholecystokinin A receptor (CCKAR) is expressed predominantly in the gallbladder and small intestine in the digestive system, where it is responsible for CCK's regulation of gallbladder and small intestinal motility. The effect of CCKAR on small intestinal transit is a physiological response for regulating intestinal cholesterol absorption. The Cckar gene has been identified to be an important gallstone gene, Lith13, in inbred mice by a powerful quantitative trait locus analysis. Knockout of the Cckar gene in mice enhances cholesterol cholelithogenesis by impairing gallbladder contraction and emptying, promoting cholesterol crystallization and crystal growth, and increasing intestinal cholesterol absorption. Clinical and epidemiological studies have demonstrated that several variants in the CCKAR gene are associated with increased prevalence of cholesterol cholelithiasis in humans. Dysfunctional gallbladder emptying in response to exogenously administered CCK-8 is often found in patients with cholesterol gallstones, and patients with pigment gallstones display an intermediate degree of gallbladder motility defect. Gallbladder hypomotility is also revealed in some subjects without gallstones under several conditions: pregnancy, total parenteral nutrition, celiac disease, oral contraceptives and conjugated estrogens, obesity, diabetes, the metabolic syndrome, and administration of CCKAR antagonists. The physical-chemical, genetic, and molecular studies of Lith13 show that dysfunctional CCKAR enhances susceptibility to cholesterol gallstones through two primary mechanisms: impaired gallbladder emptying is a key risk factor for the development of gallbladder hypomotility, biliary sludge (the precursor of gallstones), and microlithiasis, as well as delayed small intestinal transit augments cholesterol absorption as a major source for the hepatic hypersecretion of biliary cholesterol and for the accumulation of excess cholesterol in the gallbladder wall that further worsens impaired gallbladder motor function. If these two defects in the gallbladder and small intestine could be prevented by the potent CCKAR agonists, the risk of developing cholesterol gallstones could be dramatically reduced.
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Affiliation(s)
- Helen H. Wang
- Department of Medicine and Genetics, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, Einstein-Mount Sinai Diabetes Research Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Piero Portincasa
- Department of Biomedical Sciences and Human Oncology, Clinica Medica “A. Murri”, University of Bari “Aldo Moro” Medical School, 70124 Bari, Italy;
| | - Min Liu
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45237, USA; (M.L.); (P.T.)
| | - Patrick Tso
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45237, USA; (M.L.); (P.T.)
| | - David Q.-H. Wang
- Department of Medicine and Genetics, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, Einstein-Mount Sinai Diabetes Research Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
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Abstract
Congenital variants of the gallbladder development are infrequent and sometimes represent an asymptomatic imaging finding. In this case series, we want to present multimodality imaging findings that permit the diagnosis. Ultrasound, multidetector computed tomography, and magnetic resonance images are included.The proper recognition of these infrequent congenital benign entities avoids unnecessary complementary examinations and misdiagnosis. Although ultrasound represents the most commonly used initial diagnostic tool, the increased use of magnetic resonance imaging and the wide use of multidetector computed tomography make it crucial to know how these entities are seen.A retrospective review of cases of congenital variants of gallbladder through different imaging modalities was performed in our computer archives. Representative images were selected. Agenesis, hypoplasia, septated, duplicated, intrahepatic, and left-sided gallbladder are described.Better understanding and recognition of congenital anomalies in gallbladder images will avoid misdiagnosis.
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Adamski J, Mohan D, Waasdorp C. Pseudo-duplication of the Gallbladder. Clin Pract Cases Emerg Med 2019; 4:103-104. [PMID: 32064443 PMCID: PMC7012564 DOI: 10.5811/cpcem.2019.9.43332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 09/03/2019] [Accepted: 09/06/2019] [Indexed: 11/11/2022] Open
Abstract
Phrygian cap and its rare relative, pseudo-duplication of the gallbladder, are two radiologic findings that may be revealed on ultrasound evaluation. Correct identification of Phrygian cap and pseudo-duplication should trigger a careful survey of the gallbladder in its entirety to rule out pathology. These anatomic variants may lead to partial under-distension of the gallbladder and can cause the gallbladder wall to appear falsely thickened. Asymptomatic patients with this finding may be safely discharged while symptomatic patients may require further surgical consultation.
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Affiliation(s)
- Jamie Adamski
- Jefferson Northeast, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Divya Mohan
- Jefferson Northeast, Department of Emergency Medicine, Philadelphia, Pennsylvania.,Jefferson Northeast, Department of Family Medicine, Philadelphia, Pennsylvania
| | - Christopher Waasdorp
- Jefferson Northeast, Department of Emergency Medicine, Philadelphia, Pennsylvania.,Jefferson Northeast, Department of Family Medicine, Philadelphia, Pennsylvania
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Bertozzi M, Bizzarri I, Angotti R, Fusi G, Ceppi S, Di Cara G, Esposito S, Messina M, Molinaro F. Multiseptate gallbladder in a child. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Mohammed AA, Arif SH. Midline gallbladder makes a challenge for surgeons during laparoscopic cholecystectomy; case series of 6 patients. Ann Med Surg (Lond) 2019; 40:14-17. [PMID: 30962925 PMCID: PMC6423301 DOI: 10.1016/j.amsu.2019.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Gall bladder anomalies varies from variations in the size, site, duct systems, and shape. Abnormal location comprises the commonest one.The presence of an ectopic gall bladder is estimated to occur in around 0.1-0.7% of individuals, it can be truly ectopic locating under the left lobe of the liver or just to the left of falciform ligament.Gall stones are common disorder that may mandate cholecystectomy especially in symptomatic patients, surgery can be done laparoscopically safely in cases of abnormal anatomical position, but such cases may be at higher rate of complications especially if associated with other biliary tract anomalies. METHODS Six cases of symptomatic gall stones who underwent laparoscopic cholecystectomy included in this case series. During insertion of the telescope through the umbilical port, we found midline gallbladder under the falciform ligament instead being under right lobe of the liver. We did modification of the port sites by placing epigastric port in the left hypochonrdium. RESULTS In all the six cases the surgery had been done successfully laparoscopically without conversion to open technique. Follow up of the patients done for 2 months with no post-operative sequelae. CONCLUSION Laparoscopic cholecystectomy for midline gall bladder is technically difficult. Modifying the port sites make the surgery easier. MRCP preoperatively, intraoperative cholangiography, or fluorescent cholangiography may be needed if there is any concern about biliary anomalies or for real time detection of biliary injuries.
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Affiliation(s)
- Ayad Ahmad Mohammed
- University of Duhok, College of Medicine Azadi Teaching Hospital, 8 Nakhoshkhana Road, 1014, AM, Duhok City, DUHOK, Iraq
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Wang HH, Portincasa P, Wang DQH. Update on the Molecular Mechanisms Underlying the Effect of Cholecystokinin and Cholecystokinin-1 Receptor on the Formation of Cholesterol Gallstones. Curr Med Chem 2019; 26:3407-3423. [PMID: 28625150 PMCID: PMC8118134 DOI: 10.2174/0929867324666170619104801] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 05/11/2017] [Accepted: 05/11/2017] [Indexed: 02/07/2023]
Abstract
Cholecystokinin (CCK) is an important neuro-intestinal peptide hormone produced by the enteroendocrine I-cells in the upper part of small intestine. Protein- and fat-enriched food plays an important role in triggering CCK secretion from the intestine. Carbohydrates stimulate only small amounts of CCK release. The CCK-1 receptor (CCK-1R) is largely localized in the gallbladder, sphincter of Oddi, pancreas, small intestine, gastric mucosa, and pyloric sphincter, where it is responsible for CCK to regulate multiple digestive processes including gallbladder contraction, pancreatic secretion, small intestinal transit, and gastric emptying. Accumulated evidence clearly demonstrates that CCK regulates gallbladder and small intestinal motility through CCK-1R signaling cascade and the effect of CCK-1R on small intestinal transit is a physiological response for regulating intestinal cholesterol absorption. Disruption of the Cck or the Cck-1r gene in mice significantly increases the formation of cholesterol gallstones by disrupting gallbladder emptying and biliary cholesterol metabolism, as well as promoting intestinal absorption of cholesterol. Abnormalities in gallbladder motility function in response to exogenously administered CCK are found primarily in patients with cholesterol gallstones. Patients with pigment gallstones display an intermediate degree of gallbladder motility defect without gallbladder inflammation and enlarged fasting gallbladder. Dysfunctional gallbladder contractility has been found under several conditions such as pregnancy, obesity, diabetes, celiac disease, and total parenteral nutrition although gallstones are not observed. The gallbladder-specific CCK-1R-selective agonist may lead to an efficacious novel way for preventing gallstone formation by promoting gallbladder emptying, particularly for pregnant women and subjects with dysfunctional gallbladder motility function such as celiac patients, as well as patients with total parenteral nutrition.
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Affiliation(s)
- Helen H. Wang
- Department of Medicine, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Piero Portincasa
- Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | - David Q.-H. Wang
- Department of Medicine, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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Affiliation(s)
- J Kokilavani
- VK Clinic, Chromepet, Chennai, Tamilnadu, 600044, India
| | - Venkatraman Indiran
- Department of Radiodiagnosis, Sree Balaji Medical College And Hospital, 7 Works Road, Chromepet, Chennai, Tamilnadu, 600044, India.
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Abongwa HK, De Simone B, Alberici L, Iaria M, Perrone G, Tarasconi A, Baiocchi G, Portolani N, Di Saverio S, Sartelli M, Coccolini F, Manegold JE, Ansaloni L, Catena F. Implications of Left-sided Gallbladder in the Emergency Setting: Retrospective Review and Top Tips for Safe Laparoscopic Cholecystectomy. Surg Laparosc Endosc Percutan Tech 2017; 27:220-227. [PMID: 28614170 DOI: 10.1097/sle.0000000000000417] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Left-sided gallbladder without situs viscerum inversus (LSG-woSVI) is a rare congenital anomaly. Clinical features and routine presurgical imaging could miss the anomalous position, thereby producing complications during surgery. Laparoscopic cholecystectomy can be performed safely, but the risk of bile duct injury (BDI) is greater than in cholecystectomy of the orthotopic gallbladder. We present a retrospective review of all scientific literature for diagnosed cases of LSG-woSVI undergoing cholecystectomy from 1996 to 2014. Our objectives were to outline empirical top tips for a safe cholecystectomy in incidentally diagnosed LSG-woSVI. METHODS We carried a comprehensive search of PubMed using medical subject headings "left-sided gallbladder," "right-sided ligamentum teres" "situs viscerun inversus," "preoperative diagnoses," "cholecystectomy," and "bile duct injury." We considered a classification of the LSG-woSVI in 2 groups: True LSG-woSVI and LSG-woSVI in patients with right-sided ligamentum teres. RESULTS Our retrospective review revealed 55 cases of LSG-woSVI. The mean age was 51 years ±17 SD, male/female ratio was 2:1, clinical presentation was pain in the right upper abdominal quadrant in 75.5%, preoperative diagnosis was reached in 16.3%, True LSG was diagnosed in 83%, acute cholecystitis was found in 50%, laparoscopic cholecystectomy was performed in 79.6%, fundus-first dissection technique was used in 16.7%, intraoperative cholangiography was performed in 39.1%, and BDI occurred in 7.3% of the reported cases. CONCLUSIONS Increased awareness of the anatomic aberrations in LSG-woSVI associated with improved preoperative diagnosis and a good knowledge about safe surgical techniques for cholecystectomy could indubitably reduce the incidence of BDI.
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Affiliation(s)
- Hariscine K Abongwa
- *Department of Emergency and Trauma Surgery, Parma University Hospital, Parma †Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, Brescia ‡Department of Emergency and Trauma Surgery, Maggiore Hospital-Bologna Local Health District, Bologna §Departmente of Surgery, Macerata Hospital, Macerata ∥Unit of General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy ¶David Geffen School of Medicine, University of California, Los Angeles, CA
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Riaño Pinto DR. Agenesis of the gallbladder and choledocholithiasis: Case report. CASE REPORTS 2017. [DOI: 10.15446/cr.v3n2.60058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
La agenesia vesicular es la más rara de todas las malformaciones hepatobiliares. Tan sólo hay 400 casos reportados en la literatura. Ahora cómo veremos a continuación un tercio de estos pacientes desarrollan Coledocolitiasis.Exponemos entonces un caso clínico de Coledocolitiasis en una paciente de 44 años, mostrando lo difícil de estos casos. No sólo en el diagnóstico sino en el tratamiento pues hubo necesidad de realizar Coledocotomía y litotripsia para resolverlo.Finalmente queremos destacar el consenso internacional al enfrentarse ante un caso así, y las recomendaciones que existen para no lesionar la vía biliar. Haciendo una variación de los criterios de Frey.
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Deshmukh VR, Singh S, Sehgal R. Cysto-duodeno-colic ligament and its clinical relevance. Biomed J 2016; 39:414-416. [PMID: 28043421 PMCID: PMC6138514 DOI: 10.1016/j.bj.2016.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/02/2016] [Accepted: 10/11/2016] [Indexed: 01/05/2023] Open
Abstract
During a routine dissection class for the undergraduate students at All India Institute of Medical Sciences, New Delhi, a rare uncommon variation of the peritoneal ligament was found. Information regarding variation in such type of accessory peritoneal reflections is necessary for anatomists, surgeons, and radiologists. Normally there was no peritoneal reflection between gallbladder, duodenum and transverse colon, but in the present case report, it was present and termed as cysto-duodeno-colic ligament. Knowledge of such variation is necessary during gallbladder surgeries and liver transplantation surgeries.
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Affiliation(s)
| | - Seema Singh
- Department of Anatomy, All India Institute of Medical Sciences, India
| | - Ritu Sehgal
- Department of Anatomy, All India Institute of Medical Sciences, India
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Housset C, Chrétien Y, Debray D, Chignard N. Functions of the Gallbladder. Compr Physiol 2016; 6:1549-77. [PMID: 27347902 DOI: 10.1002/cphy.c150050] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The gallbladder stores and concentrates bile between meals. Gallbladder motor function is regulated by bile acids via the membrane bile acid receptor, TGR5, and by neurohormonal signals linked to digestion, for example, cholecystokinin and FGF15/19 intestinal hormones, which trigger gallbladder emptying and refilling, respectively. The cycle of gallbladder filling and emptying controls the flow of bile into the intestine and thereby the enterohepatic circulation of bile acids. The gallbladder also largely contributes to the regulation of bile composition by unique absorptive and secretory capacities. The gallbladder epithelium secretes bicarbonate and mucins, which both provide cytoprotection against bile acids. The reversal of fluid transport from absorption to secretion occurs together with bicarbonate secretion after feeding, predominantly in response to an adenosine 3',5'-cyclic monophosphate (cAMP)-dependent pathway triggered by neurohormonal factors, such as vasoactive intestinal peptide. Mucin secretion in the gallbladder is stimulated predominantly by calcium-dependent pathways that are activated by ATP present in bile, and bile acids. The gallbladder epithelium has the capacity to absorb cholesterol and provides a cholecystohepatic shunt pathway for bile acids. Changes in gallbladder motor function not only can contribute to gallstone disease, but also subserve protective functions in multiple pathological settings through the sequestration of bile acids and changes in the bile acid composition. Cholecystectomy increases the enterohepatic recirculation rates of bile acids leading to metabolic effects and an increased risk of nonalcoholic fatty liver disease, cirrhosis, and small-intestine carcinoid, independently of cholelithiasis. Among subjects with gallstones, cholecystectomy remains a priority in those at risk of gallbladder cancer, while others could benefit from gallbladder-preserving strategies. © 2016 American Physiological Society. Compr Physiol 6:1549-1577, 2016.
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Affiliation(s)
- Chantal Housset
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 938, Centre de Recherche Saint-Antoine, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Centre de Référence Maladies Rares (CMR) des Maladies Inflammatoires des Voies Biliaires (MIVB), Service d'Hépatologie, Paris, France
| | - Yues Chrétien
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 938, Centre de Recherche Saint-Antoine, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Centre de Référence Maladies Rares (CMR) des Maladies Inflammatoires des Voies Biliaires (MIVB), Service d'Hépatologie, Paris, France
| | - Dominique Debray
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 938, Centre de Recherche Saint-Antoine, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Medical-Surgical Center, Hepatology and Transplantation, Paris, France
| | - Nicolas Chignard
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 938, Centre de Recherche Saint-Antoine, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
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Öztorun Cİ, Demir R, Karakuş E, Kırsaçlıoğlu Tuna C, Bostancı SA, Şenaylı A, Azılı MN, Şenel E. WITHDRAWN: Multiseptate Gallbladder, a rare cause of recurrent abdominal pain: A case report and review of the literature. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2016.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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21
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Visualization of an Incidental Ectopic Gallbladder Location on 99mTc-MIBI Myocardial Perfusion Imaging With SPECT/CT. Clin Nucl Med 2016; 41:e152-3. [DOI: 10.1097/rlu.0000000000000981] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lo DD, Firempong AO, Cardona DM, Gulack BC, Adibe OO. Laparoscopic excision of an extra-biliary gallbladder duplication cyst in a 9-month-old infant. Afr J Paediatr Surg 2015; 12:291-3. [PMID: 26712298 PMCID: PMC4955471 DOI: 10.4103/0189-6725.172579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Duplication of the gallbladder is a rare congenital anomaly of the biliary system. We herein present a case of a 9-month-old full-term female with a prenatally identified gallbladder duplication cyst managed via laparoscopic excision.
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Affiliation(s)
| | | | | | | | - Obinna Ogochukwu Adibe
- Department of Surgery, Duke University Medical Center, Durham, NC; Division of Pediatric Surgery, Duke University Medical Center, Durham, NC, USA
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23
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The Prevalence and Classification of the Cystoduodenal Ligament. ANATOMY RESEARCH INTERNATIONAL 2015; 2015:742621. [PMID: 26347818 PMCID: PMC4549486 DOI: 10.1155/2015/742621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/30/2015] [Indexed: 11/17/2022]
Abstract
Variant patterns of peritoneal folds could be formed due to the complex nature of the embryology of the peritoneum and the gastrointestinal tract. When uncommon peritoneal folds are formed, they could influence aberrant formation of surrounding gastrointestinal structures and create spaces that may harbour peritoneal fluids in cases of infection or malignant tumor. One of such variant peritoneal folds is the cystoduodenal ligament which is a doubled peritoneal membrane attaching the gallbladder to the duodenum. Yet no study was found that had reported the frequency of occurrence of the cystoduodenal ligament. The current study determined the prevalence of the cystoduodenal ligament in forty adult cadavers. The ligament was reported in 35% of cases. The ligament was further classified as types I and II. Type I cystoduodenal ligament was attached partially to the gallbladder (neck and proximal part of body) while type II was attached to the entire extent of the gallbladder. Type I occurrence was found in 44% and type II was found in 56% of the occasions of cystoduodenal ligament formation. It is concluded that the cystoduodenal ligament could be commonly found, it possesses important vascular structures, and it could affect the shape of the gallbladder. Surgeons, radiologists, and anatomists should be kept abreast of these findings.
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24
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25
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Wagner-Bartak NA, Mukhi SV, Menias CO, Prabhakar AM, Elsayes KM. The Gallbladder. CROSS-SECTIONAL IMAGING OF THE ABDOMEN AND PELVIS 2015:145-187. [DOI: 10.1007/978-1-4939-1884-3_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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26
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Revzin MV, Scoutt L, Smitaman E, Israel GM. The gallbladder: uncommon gallbladder conditions and unusual presentations of the common gallbladder pathological processes. ACTA ACUST UNITED AC 2014; 40:385-99. [DOI: 10.1007/s00261-014-0203-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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27
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Two congenital anomalies in one: an ectopic gallbladder with phrygian cap deformity. Case Rep Radiol 2014; 2014:246476. [PMID: 24716073 PMCID: PMC3971497 DOI: 10.1155/2014/246476] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 01/30/2014] [Indexed: 11/17/2022] Open
Abstract
The gallbladder is affected by a large number of congenital anomalies, which may affect its location, number, size, or form. Some of these malformations are very rare and may lead to misdiagnosis. An ectopic gallbladder can be misinterpreted as agenesis of the organ or as a cystic hepatic mass when intrahepatic. Given the frequency and the wide acceptance of the ultrasonographic examination of the biliary tract, radiologists should be aware of these malformations. In some cases, ultrasonographic diagnosis can be difficult. However, the use of Computed Tomography can elucidate such cases. We present the case of a patient whose gallbladder had two combined malformations but caused no symptoms. Namely, the patient had a transverse ectopic gallbladder combined with a "Phrygian cap" deformity. The incidence of ectopic locations of the gallbladder is 0.1-0.7%, whereas the "Phrygian cap" deformity can be found in 4% of patients. There is no other cases with combination of these two entities reported in the literature. Ultrasonographic and CT findings are presented and aspects of this malformation are discussed. The clinical significance of ectopic gallbladder is also emphasized because it may alter the clinical presentation of biliary tract diseases and pose technical problems during surgery.
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Abstract
A Phrygian cap is a congenital anomaly of the gallbladder with an incidence of 4%. It can simulate a mass in the liver during hepatobiliary imaging and is sometimes mistaken for pathology. A Phrygian cap, however, has no pathological significance and normally causes no symptoms. A case will be presented where a Phrygian cap was found by coincidence during surgery. The patient was operated for colon cancer with liver metastasis in segment V. He underwent a simultaneous right hemicolectomy and wedge resection of the liver lesion. During perioperative inspection, a gallbladder with a folded fundus was seen. This deformity was, in retrospective, detected on the preoperative MRI scan. The patient underwent cholecystectomy to make the wedge resection easier to perform. Otherwise, cholecystectomy for a Phrygian cap is only indicated in case of symptoms. Radiographic imaging can be helpful in narrowing the differential diagnosis. To our knowledge, there is no recent literature about the Phrygian cap and its imaging aspects. Nowadays, multiphase MRI, or multiphase CT in case of MRI contraindication, are the first choices of hepatobiliary imaging.
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29
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Ptotic gall bladder with hepatic masses: a case report. Case Rep Radiol 2013; 2013:854686. [PMID: 23476872 PMCID: PMC3582077 DOI: 10.1155/2013/854686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 01/09/2013] [Indexed: 11/26/2022] Open
Abstract
Gall bladder (GB) may be found in a variety of abnormal positions. Most of them are due to arrested development of embryonic growth at different stages. A 63-year-old female patient was admitted to our radiology unit for magnetic resonance imaging (MRI) of the liver for the lesions identified in abdominal ultrasonography (US) and computed tomography (CT). MRI showed that there was a lobulated heterogenous mass in the left lobe of the liver and a smaller one in the right lobe of the liver with the same appearance. The inferior pole of the liver was located in the pelvic space, and the GB, which contained sludges and stones, was lying down to the upper pelvic space. Hepatic masses were considered to be hemangiomas, and GB was diagnosed as ptotic GB with luminal sludge and stones. In this case, especially, MR imaging helped the surgeon to plan a proper approach to the GB in abnormal localization.
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30
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Rajguru J, Khare S, Jain S, Ghai R, Singla M, Goel P. Variations in the External Morphology of Gall Bladder. J ANAT SOC INDIA 2012. [DOI: 10.1016/s0003-2778(12)80004-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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31
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Agarwal V, Pande S, Garg SK, Jangid DR. Anomalously placed suprahepatic gall-bladder: A case detected on F-18 FDG PET/CT. Indian J Nucl Med 2011; 26:120-2. [PMID: 22174525 PMCID: PMC3237217 DOI: 10.4103/0972-3919.90270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The purpose of this study was to appraise the imageologists of a possible mislocalization of tracer accumulation to anomalously placed gallbladder during positron emission tomography-computed tomography (PET/CT) examination. PET/CT is increasingly playing an important role in staging and restaging of the disease process in cancer patients. With the advent of fusion imaging, the tracer accumulation can be correctly localized to a structure or lesion on CT. We did a staging PET/CT scan of a patient with hepatocellular carcinoma for liver transplant evaluation. Fluorine-18 fluorodeoxyglucose (F-18 FDG) was used as a tracer and the scan was performed on SEIMENS Biograph-mCT PET/CT machine. We noted the tracer accumulation at the superior surface of liver, which was localized to the anomalously placed gallbladder in suprahepatic subdiaphragmatic location. The anomalously placed gallbladder can create localization confusion. Keeping the possibility of ectopically placed gallbladder in mind, the imageologist can better localize the tracer uptake.
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Affiliation(s)
- Vishal Agarwal
- Departments of Nuclear Medicine and Radiology, Medanta - The Medicity Hospital, Sector-38, Gurgaon, India
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33
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34
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A Diagnostic Dilemma of Atypical Gallbladder Appearance on Tc-99m HIDA Cholescintigraphy Resolved With SPECT/CT. Clin Nucl Med 2011; 36:160-3. [DOI: 10.1097/rlu.0b013e3181feed6d] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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Hung HH, Chen TS, Chau GY. An unusual cause of abdominal pain in a cirrhotic patient. Gastroenterology 2010; 138:e3-4. [PMID: 20109591 DOI: 10.1053/j.gastro.2009.05.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 05/11/2009] [Accepted: 05/27/2009] [Indexed: 12/02/2022]
Affiliation(s)
- Hung-Hsu Hung
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
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36
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Affiliation(s)
- Manju B. Popli
- Department of Radiological Imaging and NMR Research Centre, Institute of Nuclear Medicine and Allied Sciences, Lucknow Road, Delhi - 110 054, India.
| | - Vineet Popli
- Aruna Asaf Ali Hospital, Rajpur Road, New Delhi - 110 054, India
| | - Yachna Solanki
- Department of Radiological Imaging and NMR Research Centre, Institute of Nuclear Medicine and Allied Sciences, Lucknow Road, Delhi - 110 054, India
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37
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Jung HS, Huh K, Shin YH, Kim JK, Yun CS, Park CH, Jang JB. Left-sided gallbladder: a complicated percutaneous cholecystostomy and subsequent hepatic embolisation. Br J Radiol 2009; 82:e141-4. [PMID: 19541942 DOI: 10.1259/bjr/59092209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
A 68-year-old male patient with chronic hypertension, diabetes mellitus and chronic renal failure was diagnosed with acute calculous cholecystitis. A percutaneous cholecystostomy using a transperitoneal approach was performed after two failed attempts with a right-sided transhepatic approach. Subsequent hepatic embolisation was performed for the treatment of haemoperitoneum due to hepatic injury after the percutaneous cholecystostomy. The presence of a left-sided gallbladder was confirmed by laparoscopic cholecystectomy after 1 week. Prior identification of this anomaly would have prevented hepatic injury through the use of a cautious procedure against mobility or careful selection of the approach routes. In conclusion, the transperitoneal approach can be easier or more preferable to perform for a percutaneous cholecystostomy of a left-sided gallbladder.
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Affiliation(s)
- H S Jung
- Department of Diagnostic Radiology, Bongsaeng Memorial Hospital, Busan, Korea.
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38
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Hsu SL, Chen TY, Huang TL, Sun CK, Concejero AM, Tsang LLC, Cheng YF. Left-sided gallbladder: Its clinical significance and imaging presentations. World J Gastroenterol 2007; 13:6404-9. [PMID: 18081230 PMCID: PMC4205460 DOI: 10.3748/wjg.v13.i47.6404] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the importance of preoperative diagnosis and presentation of left-sided gallbladder using ultrasound (US), CT and angiography.
METHODS: Retrospective review of 1482 patients who underwent enhanced CT scanning was performed. Left-sided gallbladder was diagnosed if a right-sided ligamentum teres was present. The image presentations on US, CT and angiography were also reviewed.
RESULTS: Left-sided gallbladder was diagnosed in nine patients. The associated abnormalities on CT imaging included portal vein anomalies, absence of umbilical portion of the portal vein in the left lobe of the liver, club-shaped portal vein in the right lobe of the liver, and difficulty in identifying segment IV. Angiography in six of nine patients demonstrated abnormal portal venous system (trifurcation type in four of six patients). The main hepatic arteries followed the portal veins in all six patients. The segment IV artery was identified in four of six patients using angiography, although segment IV was difficult to define on CT imaging. Hepatectomy was performed in three patients with concomitant liver tumor and the diagnosis of left-sided gallbladder was confirmed intraoperatively.
CONCLUSION: Left-sided gallbladder is an important clinical entity in hepatectomy due to its associated portal venous and biliary anomalies. It should be considered in US, CT and angiography images that demonstrate no definite segment IV, absence of umbilical portion of the portal vein in the left lobe, and club-shaped right anterior portal vein.
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39
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Safioleas MC, Papavassiliou VG, Moulakakis KG, Angouras DC, Skandalakis P. Congenital Duplication of the Gallbladder. Am Surg 2006. [DOI: 10.1177/000313480607200304] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Duplication of the gallbladder is a rare congenital anomaly of the biliary system. In this article, two cases of gallbladder duplication are presented. The first case is a patient with double gallbladder and concomitant choledocholithiasis. The probable diagnosis of double gallbladder was made preoperatively by computed tomography. The patient underwent a successful open cholecystectomy and common bile duct exploration. In the second case, two cystic formations in the place of gallbladder are demonstrated with ultrasound scan in a woman with acute cholecystitis. At surgery, two gallbladders were found. A brief review of epidemiology and anatomy of double gallbladder is included, along with a discussion of the difficulties in diagnosis and treatment of this condition.
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Affiliation(s)
- Michael C. Safioleas
- From the Second Propedeutic Surgery Department, University of Athens, School of Medicine, “Laiko” General Hospital, Athens, Greece
| | - Vassilios G. Papavassiliou
- From the Second Propedeutic Surgery Department, University of Athens, School of Medicine, “Laiko” General Hospital, Athens, Greece
| | - Konstantinos G. Moulakakis
- From the Second Propedeutic Surgery Department, University of Athens, School of Medicine, “Laiko” General Hospital, Athens, Greece
| | - Dimitrios C. Angouras
- From the Second Propedeutic Surgery Department, University of Athens, School of Medicine, “Laiko” General Hospital, Athens, Greece
| | - Panagiotis Skandalakis
- From the Second Propedeutic Surgery Department, University of Athens, School of Medicine, “Laiko” General Hospital, Athens, Greece
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40
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Grand D, Horton KM, Fishman EK, Fishman E. CT of the gallbladder: spectrum of disease. AJR Am J Roentgenol 2004; 183:163-70. [PMID: 15208132 DOI: 10.2214/ajr.183.1.1830163] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- David Grand
- Department of Radiology, Johns Hopkins Hospital, 601 N Caroline St., JHOC 3253, Baltimore, MD 21287, USA
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41
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Drocea CW, Budorick NE, Kim AE, Fawwaz R, Van Heertum RL. Biliary scintigraphy and ultrasound demonstrating an S-shaped gallbladder with a calculus and narrowing at its midportion. Clin Nucl Med 2002; 27:589-90. [PMID: 12170006 DOI: 10.1097/00003072-200208000-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Charles W Drocea
- Department of Radiology, Division of Nuclear Medicine, Columbia-Presbyterian Medical Center, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA
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42
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Mouratidis B, Chen SW. A false-negative hepatobiliary scan due to the infected fundal end of a septated gallbladder. Clin Nucl Med 2001; 26:784-5. [PMID: 11507300 DOI: 10.1097/00003072-200109000-00011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- B Mouratidis
- Department of Medical Imaging, The Canberra Hospital, Yamba Drive, Garran ACT, Canberra, Australia 2605.
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43
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Kim YS, Kim Y, Cho OK, Koh BH, Rhim H, Park DW, Park CK. Sonography for right lower quadrant pain. JOURNAL OF CLINICAL ULTRASOUND : JCU 2001; 29:157-185. [PMID: 11329159 DOI: 10.1002/1097-0096(200103/04)29:3<157::aid-jcu1016>3.0.co;2-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- Y S Kim
- Department of Diagnostic Radiology, College of Medicine, Hanyang University, 249-1, Kyomoon-dong, Kuri-si, Kyounggi-do 471-701, South Korea
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44
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Martinoli C, Derchi LE, Pastorino C, Cittadini G. Case report: imaging of a bilobed gallbladder. Br J Radiol 1993; 66:734-6. [PMID: 7719690 DOI: 10.1259/0007-1285-66-788-734] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Imaging of the gallbladder demonstrates a wide range of anatomical variants, including anomalies in location, number and shape. Duplication anomalies are quite rare and are characterized by a large variety of configurations depending on the size and degree of fusion of the two lobes, and on the number and disposition of the cystic ducts. We present a case of a deeply cleft, bilobed gallbladder imaged by computed tomography (CT), ultrasonography (US) and oral cholecystography (OCG). The anomaly consisted of complete duplication of the body and fundus into two distinct and separated lobes both of which entered a single infundibulum. Awareness of congenital gallbladder variants may help in recognizing and correctly classifying gallbladder abnormalities, thus preventing misdiagnoses.
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Affiliation(s)
- C Martinoli
- Institute of Radiology, University of Genoa, Italy
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