Congenital Bilobed Gallbladder with Phrygian Cap Presenting as Calculus Cholecystitis

Abstract

The incidence of congenital bilobed gall bladder is 1 in 3000 to 4000. A Phrygian cap is a congenital abnormality of the gallbladder with an incidence of 4%. Preferred mode of diagnosis for Phrygian cap is cholescintigraphy and multi phase MRI, as Ultrasonography and CT are not always conclusive. The estimated prevalence of gallstone disease in India has been reported as 2% to 29%. A case of bilobed gall bladder with Phrygian cap in both the lobes and pigment gallstone in one of the lobes presenting as calculus cholecystitis is reported for its rarity and difficulty in arriving at correct preoperaive diagnosis.

Unsuspected Phrygian Cap Gallbladder in a 71 Year Old Man

“…3,4 However, if associated with cholelithiasis or cholecystitis, the chances of clinical diagnosis increase. 2 The diagnosis of Phrygian cap gallbladder herein described was incidental in a routine check up. The anomaly was characterized by observing the classical images of the ultrasound scan, and the defect was further confirmed on evaluation of the specimen removed by laparoscopic cholecystectomy.…”

“…3 Folding or bending of the fundus over the body gives origin to a deformity called Phrygian cap gallbladder, similar to a headgear used by liberated Greek slaves of an ancient Turkish region. [2][3][4][5] Phrygian cap gallbladder is a rare congenital anomaly whose incidence is probably underestimated. This condition is more often incidentally diagnosed during cholecystectomies or autopsies.…”

“…An initial concern was about bilobed gallbladder with a Phrygian cap,which is exceedingly rare. 2 Other hypotheses were pouch or diverticulum, duplication, septate and hour glass gallbladder.…”

“…[1][2][3][4] This abnormality was first described by Boyden in 1935, [2][3][4][5] and its estimated incidence is 4%. [2][3][4] This developmental defect appears as folded gallbladder and results from kinking between the body and the fundus or the infundibulum. These deformities predispose to cholelithiasis due to biliary stasis in the corpus and fundus of the gallbladder.…”

“…These deformities predispose to cholelithiasis due to biliary stasis in the corpus and fundus of the gallbladder. 1 Phrygian cap anomaly by itself does not suggest invasive intervention, [2][3][4] but the suspicion of associated gallbladder polypsmay indicate the needfor surgical management. [7][8][9] The malignant potential of 10 mm polyps is high, but the smallerones must also be monitored.…”