La tunisie Medicale - 2011 ; Vol 89 ( n°010 ) : 798-799
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Article
Congenital duplication of the gallbladder has been reported as a rare congenital anomaly with an incidence of 1 in 3800-4000 autopsies (1, 2). Preoperative diagnosis and definition of the biliary duct abnormalities is important to prevent inadvertent damage to the biliary system, complicated postoperative course.We report here a case of five years old girl with duplicated gallbladder diagnosed preoperatively and treated.

Case report

Afive years old girl presented with one year history of jaundice,heapatomegaly splenomegaly and pancytopenia, with the explorations of this haemolytic jaundice concluded to a hereditary spherocytosis. Abdominal ultrasound (figure 1) suggested a double gallbladder with stone. The common hepatic, intrahepatic and extra hepatic biliary ducts had an abnormal calibre, with hepato-splenomegaly. Magnetic resonance cholangiography (figure 2) was done and showed a duplication of gallbladder with stones and a minim dilatation of the common biliary duct without stones. On exploration, there was two gallbladders, one smaller accessory gallbladder was located anterior to the main one (Figure 3). The accessory cystic artery was isolated after careful dissection of Calot’s triangle and clips were placed on it. Two cystic ducts (main and accessory cystic ducts) were detected. The duct of accessory gallbladder joined separately with the main cystic duct in the common biliary duct. After division of the cystic duct and vessels, the gallbladders were retracted cephalically,peritoneum was incised and the duplicated gallbladders are dissected from the liver. The per-operative cholangiography (figure 4) confirms the diagnosis and showed double cystic ducts communicating with the common biliary duct without anatomy abnormalities. There were no vascular abnormalities noted. Bicholecystectomy was successfully completed. No drain was used in the patient. The duration of the operation was 50 minutes. The postoperative period was uneventful, and the patient was discharged on the third postoperative day. She was free of symptoms 12 months later. After the operation, the biliary stones were removed. We couldn’t find any stone in accessory gallbladder. Histopathology findings showed 2 distinct gallbladders, each measuring respectively 4 and 7 cm in length with normal gallbladder mucosa.

Figure 1 : Ultrasound: duplicate gallbladder



Figure 2 : Magnetic resonance cholangiography showed a duplication of gallbladder with a minim dilatation of the common biliary duct without stone.



Figure 3 : The duct of accessory gallbladder joined separetely with the main cystic duct in the common biliary duct.



Figure 4 : The per-operative cholangiography showed double cystic ducts communicating with the common biliary duct without anatomy abnormalities.



Conclusion

The congenital gallbladder duplication is a rare entity. Precise intraoperative recognition of vascular and biliary anatomy including abnormalities is necessary to avoid mistakes during surgery.
Références
  • Boyden EA: The accessory gallbladder: An embryological and comparative study of aberrant biliary vesicles occurring in man and domestic animals. Am J Anat 1926, 38: 177-231.
  • Hadaffis N, Gray SW. Multiple gallbladders. Sur Gynecol Obstet 1977; 145- 928
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Enfant traitement diagnostic Chirurgie Maladie de crohn Tunisie pronostic dépistage Coelioscopie Cancer Cancer du sein Ostéoporose mammographie prévention échographie
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