Gall bladder duplication is a rare congenital anomaly. True duplication is still rarer. Pre-operative detection helps in avoiding complications or missing the gall bladder during surgery. Ultrasonography (USG) and magnetic resonance cholangiography are investigation of choice. Laparoscopic cholecystectomy is the preferred modality for management of double gall bladder. We present a case diagnosed as cholelithiasis on USG. While doing laparoscopic surgery 2 gall bladders were found. She had a normal gall bladder that was lying in the supraduodenal area. It had cystic duct that joined the common bile duct. There was an accessory gall bladder attached to the anterior free margin of the liver. This gallbladder was occluded with a big solitary calculus occupying the whole of gall bladder cavity and had a small feeding vessel; whereas its duct had fibrosed.
This is a rare presentation. A farmer aged 52 years old was brought to the emergency service of Government District (Doon) Hospital in the late evening having significant bleeding per rectum. He had injured his perineum on a sharp wooden stick during a fall near a tube well. The wooden stick had been extracted by his relatives, which had resulted in profuse bleeding. The patient was managed with intravenous crystalloids and rushed to the operating theatre for examination under analgesia. Blood transfusion was arranged and the wound explored under general anaesthesia. The patient had unusual associated visceral injuries as well as sphincter, rectum, urinary bladder, ileal loop and mesentery injuries. The injured bowel, mesentery, urinary bladder and rectum were repaired with diversion of the upper pelvic colon. In addition, debridement of the perineal wound with rectal sphincter repair was performed and the presacral space drained. The colostomy was closed after 3 months, and the patient survived and is continent.
A 65-year-old woman from a rural area presented to the surgical service with a very large abdominal lump that the patient had first noticed 8 years previously. The lump had steadily increased in size over time, and the patient had dysuria, weakness and dyspnoea on exertion. On examination she was grossly anaemic with a large retroperitoneal lump that occupied the whole right side of abdomen; the lump was soft to firm in consistency and non-tender. She had no lymphoedema or other palpable lymph nodes. Ultrasound revealed a large retroperitoneal tumour with fatty elements, arising from the right kidney. There was no involvement of the intestines. Findings of the computed tomography scan were typical for renal angiomyolipoma. The patient underwent surgery and the tumour was excised. Four units of blood were transfused preoperatively and in addition two units were given postoperatively. The patient was given thromboprophylaxis perioperatively and in the postoperative period because she was bedridden and could not ambulate. She made an uneventful recovery.
Double gall bladder or duplication of the gall bladder is a rare congenital malformation. It poses a challenge to the surgeon and the radiologist, both in preoperative evaluation and intraoperative management. In the era of minimal invasive surgery, clear knowledge of extrahepatic biliary anatomical variations is very much essential. The operating surgeon should be very careful and overcautious in identifying such variations to prevent untoward biliary tract injury. In this series of two cases, we present the clinical peculiarities, preoperative diagnosis, and laparoscopic management of the duplicate gall bladder.
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