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Ectopic gallbladder with congenital biliary dilatation: a pediatric case report
Kanako Omata1, Mariko Yoshida1, Kan Suzuki1
1Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan.
Insights
This case report details a rare pediatric ectopic gallbladder found alongside congenital biliary dilatation (CBD). Early recognition of ectopic gallbladder is crucial for accurate diagnosis and management in children.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Imaging
Background:
- Ectopic gallbladder is a rare congenital anomaly that can lead to diagnostic challenges.
- Congenital biliary dilatation (CBD) is a serious condition requiring prompt management.
- This report focuses on a pediatric case involving both ectopic gallbladder and CBD.
Purpose of the Study:
- To report a unique pediatric case of ectopic gallbladder co-occurring with congenital biliary dilatation (CBD).
- To highlight the importance of considering ectopic gallbladder in preoperative imaging assessments.
- To describe the successful surgical management of this rare condition.
Main Methods:
- A 9-year-old girl with elevated liver enzymes was diagnosed with Todani type IV-A CBD.
- Preoperative imaging (ultrasonography, CT, MRI) failed to visualize the gallbladder, suggesting agenesis.
- Laparoscopic excision of the extrahepatic bile duct and hepaticojejunostomy were performed, revealing an ectopic gallbladder during surgery.
Main Results:
- An ectopic gallbladder, initially missed on imaging, was identified during surgery for CBD.
- The patient underwent successful laparoscopic treatment for both conditions.
- Histopathological examination confirmed the ectopic gallbladder diagnosis.
Conclusions:
- This is the first reported pediatric case of ectopic gallbladder concomitant with CBD.
- The case underscores the necessity of suspecting ectopic gallbladder when the gallbladder is not visualized preoperatively.
- Accurate diagnosis and surgical intervention are vital for favorable outcomes in such rare anomalies.
Background:
An ectopic gallbladder is a rare anomaly and can result in the misinterpretation of imaging findings and clinical confusion. Knowledge of such anomalies facilitates accurate diagnoses and prompt management. We report a pediatric case of an ectopic gallbladder concomitant with congenital biliary dilatation (CBD).
Case Presentation:
A 9-year-old girl was referred to our hospital for elevated liver enzyme levels. Following physical examination and a review of medical imaging findings, she was diagnosed with Todani type IV-A CBD. We could not visualize the gallbladder by abdominal ultrasonography, CT, and MRI scans; therefore, we suspected gallbladder agenesis. A laparoscopic excision of the extrahepatic bile duct was performed to treat the CBD. Neither a gallbladder nor a cystic duct were revealed on the liver undersurface. Therefore, gallbladder agenesis was considered as a diagnosis based on preoperative imaging and intraoperative findings. However, during dissection of the hepatic hilum, a cyst-like structure was found on the ventral side of the common hepatic duct, slightly to the right, and a small additional duct that originated from the cystic structure was found. Upon incision, a small amount of bile was drained from the small duct. Thus, the cystic structure was diagnosed as an ectopic gallbladder with hypoplasia. Following the removal of the ectopic gallbladder, the extrahepatic bile duct was excised. Subsequently, laparoscopic Roux-en-Y hepaticojejunostomy was performed without any complications. Postoperative histopathological evaluations of the resected specimen revealed Rokitansky-Aschoff sinuses in the resected cystic lesion. The pathological investigations confirmed the diagnosis of an ectopic gallbladder. Following an uneventful postoperative course, the patient was discharged on day nine.
Conclusions:
To our knowledge, this is the first pediatric case report describing an ectopic gallbladder concomitant with CBD. If the gallbladder cannot be detected in a preoperative imaging examination, it is important to consider the possibility of an ectopic gallbladder.
