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Laparoscopic cholecystectomy for double gallbladder malformation with cystic duct variation: a case report
Shaohua Yang1, Xiaohui Gu2, Liping Ma3
1Hepatobiliary and Pancreatic Surgery Department, Qujing Central Hospital, Yunnan Province, Qujing, Yunnan, China.
Background:
Double gallbladder associated with cystic duct variation is a rare congenital biliary anomaly that carries a high risk of intraoperative misdiagnosis.
Case Presentation:
We report a case involving a 20-year-old female who presented with right upper quadrant pain. Based on clinical findings and preoperative abdominal magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP), she was diagnosed with gallbladder stones complicated by acute cholecystitis and a double gallbladder malformation, initially classified as the Y-type variant of Harlaftis Type I. Intraoperative exploration revealed two separate gallbladders sharing a single cystic artery; however, the actual anatomy did not fully correspond to the preoperative imaging assessment. Given the presence of anomalous biliary structures and intraoperative bile leakage, an intraoperative cholangiogram (IOC) was performed to delineate the biliary anatomy. IOC showed that each gallbladder drained via its own cystic duct into the common hepatic duct: one cystic duct coursed parallel to the common hepatic duct and joined it at a low insertion point, while the other connected in the typical fashion. Integrating operative findings with IOC results, the malformation was reclassified as an H-type double gallbladder (Harlaftis Type II) with an abnormally low cystic duct confluence. Laparoscopic double cholecystectomy was successfully completed under IOC guidance.
Conclusions:
This case highlights that although MRI/MRCP can aid in the preoperative detection and preliminary classification of double gallbladder anomalies, imaging may not accurately reflect the true intraoperative anatomy when complex cystic duct variations are present. When intraoperative observations deviate from preoperative expectations or pose a risk of biliary injury, prompt use of IOC is essential to clarify biliary anatomy, correct diagnostic discrepancies, prevent iatrogenic injury, and ensure surgical safety.
