IntroductionGallbladder duplication is a rare congenital malformation that occurs in about one in 4000 births. Congenital anomalies of the gallbladder and anatomical variations of their positions are associated with an increased risk of complications after laparoscopic cholecystectomy.Presentation of caseWe report the case of a double gallbladder in a fifty-six year old man. He presented with recurrent episodes of biliary colic. Pre-operative imaging confirmed the diagnosis. He subsequently underwent surgery for biliary colic.DiscussionInspection of the resected gallbladder specimen showed that it consisted of two chambers with a single cystic duct, which communicated through a common ostium. Both chambers had cholelithiasis. There were two cystic arteries as well. Duplication of the gallbladder has an incidence of approximately 1: 4000. However, the exact incidence of this rare anomaly cannot be accurately assessed, since the only cases which have been identified are those that became symptomatic or were encountered as incidental findings during surgery, imaging studies or at autopsy.ConclusionDuplication of the gallbladder is a rare congenital abnormality, which requires special attention to the biliary ductal and arterial anatomy. Laparoscopic cholecystectomy with intraoperative cholangiography is the appropriate treatment in a symptomatic gallbladder. The removal of an asymptomatic double gallbladder remains controversial.

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HighlightsLaparoscopic femoral hernia repair is not the standard of care in patients.Once the learning curve has been breached however this procedure is reproducible.This case report is from a rural hospital in Northern Saskatchewan, Canada.Laparoscopic femoral hernia repair is possible even in rural centres.

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Superior mesenteric artery (SMA) syndrome is a rare cause of duodenal obstruction and its management is usually conservative with nasojejunal feeding. The pathophysiology entails the loss of the fat pad between the superior mesenteric artery and the abdominal aorta. This reduces the angle between the two vessels to less than 20 degrees with the resultant compression of the third part of the duodenum. The surgical management is usually a laparoscopic duodenojejunostomy. The two cases in our series had two different surgical procedures with good outcomes in both patients. The surgical management of each patient should be determined on its own merits irrespective of the standard of care.

Extra-adrenal myelolipomas (EAMLs) are extremely rare soft tissue tumours that constitute <15% of all myelolipomas. We present a 70-year-old patient with a midline swelling of the anterior abdominal wall. It was clinically diagnosed as an incisional hernia, though the computerized scan indicated an internal hernia. During laparoscopy a soft tissue tumour of the abdominal wall was identified and excised. Pathology confirmed an extra-adrenal myelolipoma of the anterior abdominal wall through the presence of adipocytes and trilineage haematopoetic cell lines. EAMLs are rare mesenchymal soft tissue tumours with less than a hundred cases reported in the English literature. Pathological diagnosis shows the presence of mature adipocytes as well as myeloid and erythroid cell lines. This is the first case report of an EAML of the anterior abdominal wall. This case report is made even more rare as it is present in a male patient.

Incisional hernias involving the falciform ligament have only been reported in two case reports in the English literature. This is the first reported case series of two falciform ligament incisional hernias. Both patients had undergone a prior cholecystectomy. Laparoscopic transabdominal pre-peritoneal repair was performed with an uneventful recovery in both patients. In the previously published reports both patients underwent an open herniorrhaphy with an underlay mesh repair. These are the first two documented laparoscopic repairs of a falciform ligament incisional hernia. The laparoscopic repair also included intra-corporeal suturing of the hernia necks with a non-absorbable suture. We extrapolated this data from the component separation technique which reconstituted the abdominal musculature in their normal anatomical position resulting in a reduced hernia recurrence rate.

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