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 phenomenon. Gallbladder duplication is an even rarer phenomenon. Pathological processes are more common in congenital anomalies of the gall bladder than normal gallbladders due to poor drainage.

Case report: We present a case of duplex gallbladder with one component intrahepatic and the other extra-hepatic, the duo draining via a common cystic duct into the common bile duct. Both gallbladder moieties were diseased. The intrahepatic moiety was gangrenous and perforated thus mimicking an intrahepatic abscess by a gas forming organism. The extra-hepatic moiety was chronically inflamed and packed with gallstones of the same physical and biochemical characteristics as the intrahepatic moiety. The definitive diagnosis was only made at emergency laparotomy. Stone gathering and debridement of the ruptured, gangrenous intrahepatic moiety and cholecystectomy for the extra-hepatic moiety was 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 world literature. Though rare, congenital anomalies of the gallbladder must be known to surgeons as they can present unexpectedly and pose diagnostic and operative surgical challenges with serious clinical implications. The management challenges experienced and literature review is presented.