Choledochal cyst or gallbladder duplication? Diagnostic laparoscopy for chronic abdominal pain in a 10 year old boy

Abstract

Structural abnormalities in close proximity with the gallbladder fossa such as gallbladder duplications could be misrepresented as choledochal cysts, duodenal duplication cysts or gallbladder adenomyomas on sonography. We present a case of a ten year old boy who presented with a chronic abdominal pain of a three month duration and nausea and vomiting. Ultrasound and magnetic resonance cholangiopancreaticoography (MRCP) was reported by radiology as a possible 2.7 x 1.7 x 1.6 cm choledochal cyst with high differential consideration for a gallbladder duplication. The patient underwent a diagnostic laparoscopy and a grossly normal gallbladder was visualized with no gross visualization of cystic biliary tree dilatation. The gallbladder was successfully resected laparoscopically following a meticulous dissection of the triangle of calot. Pathology showed evidence of a septate gallbladder with a common cystic duct and no evidence of cholelithiasis. The patient is two years post -laparoscopic cholecystectomy and remains symptom-free. Successful laparoscopic resection of a duplicate gallbladder requires a pre-operative diagnostic delineation of the biliary tree anatomy to rule out other possible differentials.