Congenital duplex gallbladder anomaly presenting as gangrenous perforated intrahepatic cholecystitis mimicking a gas forming liver abscess: A case report and literature review

Background: Ectopic intrahepatic gallbladder is a rare phenom enon. G allb ladder duplication is an even rarer phenom enon. Pathological processes arc m ore com m on in congenital anom alies o f the gall bladder than norm al gallbladders due to poor drainage. Case Report: We present a case o f duplex gallbladder with one com ponent intrahepatic and the o ther extrahepatic, the duo draining via a com m on cystic duct into the com m on bile duct. Both gallb ladder m oieties were diseased. The intrahepatic m oiety was gangrenous and perforated thus m im icking an intrahepatic abscess by a gas form ing organism .The extra-hepatic m oiety was chronically inflam ed andpacked w ith gallstones o f the sam e physical and biochem ical characteristics as the intrahepatic moiety. The definitive diagnosis was only m ade at em ergency laparotom y. Stone gathering and debridem ent o f the ruptured, gangrenous intrahepatic m oiety and cholecystectom y for the extra-hepatic m oiety w as done. On table cholangiography, though desired, was not available. The patient fully recovered after post-operative intensive care. Conclusion: An extensive internet literature search did not reveal any previously described case. This could be the first such case described in the w orld literature. Though rare, congenital anom alies o f the gallbladder m ust be know n to surgeons as they can present unexpectedly and pose diagnostic and operative surgical challenges w ith serious clinical im plications. The m anagem ent challenges experienced and literature review is presented. Cent A fr J M ed 2012:58(1/4) 44-49