Al Rawahi Aziza, Al Azri Yahya, Al Jabri Salah, Alfadli Abdulrazaq, Al Aghbari Suad
Department of General Surgery, Hepatobiliary Surgery Unit, The Royal Hospital, P.O. Box 866, PC 130 Athaiba, Muscat, Oman.
Int J Surg Case Rep. 2016;21:142-6. doi: 10.1016/j.ijscr.2016.03.002. Epub 2016 Mar 6.
Gallbladder duplication is a rare congenital anomaly. Recognition of this anomaly and its various types is important since it can complicate a simple hepatobiliary surgical procedure.
We report a case of a 42 year old female who presented a 6 year history of intermittent right upper quadrant abdominal pain. Her basic blood investigations including liver function tests were normal. Pre-operative imaging revealed a cystic lesion communicating with biliary tree representing duplicated gallbladder. She subsequently underwent successful laparoscopic cholecystectomy. The operative challenges were more than those anticipated at the usual laparoscopic gallbladder procedures. After six months follow up the patient remained asymptomatic.
Preoperative diagnosis plays a crucial role in planning surgery, and preventing possible biliary injuries or re-operation if accessory gallbladder has been overlooked during initial surgery. Magnetic resonance cholangiopancreatography (MRCP) is the imaging modality of choice for suspected duplicate gallbladder. Laparoscopic cholecystectomy for duplicate gallbladder is a challenging operation and should be performed with meticulous dissection of the cysto-hepatic triangle.
Gallbladder anomalies should be anticipated in the presence of a cystic lesion reported around the gallbladder. The laparoscopic cholecystectomy remains feasible for intervention and should be done by an experienced laparoscopic surgeon.
胆囊重复是一种罕见的先天性异常。认识到这种异常及其各种类型很重要,因为它会使简单的肝胆外科手术变得复杂。
我们报告一例42岁女性,有6年间歇性右上腹腹痛病史。她包括肝功能检查在内的基本血液检查均正常。术前影像学检查发现一个与胆道相通的囊性病变,提示胆囊重复。她随后成功接受了腹腔镜胆囊切除术。手术挑战比通常的腹腔镜胆囊手术预期的更多。经过六个月的随访,患者仍无症状。
术前诊断在手术规划中起着关键作用,并可防止在初次手术中遗漏副胆囊时可能发生的胆道损伤或再次手术。磁共振胆胰管造影(MRCP)是疑似胆囊重复时的首选成像方式。腹腔镜胆囊切除术治疗重复胆囊是一项具有挑战性的手术,应仔细解剖胆囊肝三角进行。
在胆囊周围报告有囊性病变时,应考虑胆囊异常。腹腔镜胆囊切除术对于干预仍然可行,应由经验丰富的腹腔镜外科医生进行。