0:01

This following patient is a seven-year-old

0:03

male who actually presents with right lower

0:05

quadrant pain, and they got a CT scan to

0:08

evaluate the cause of the patient's symptoms.

0:12

It actually showcases a really interesting finding.

0:14

It's one of my more favorite

0:15

cases because it's so rare.

0:17

It's really hard to find this.

0:19

So let's scroll down.

0:20

This is a contrast-enhanced CT scan.

0:22

I'm going to zoom in a little bit.

0:24

And again, we're going to focus on the gallbladder.

0:27

So let's go slowly through evaluating the gallbladder.

0:30

We can see that sort of structure over here

0:31

filled with bile, low-density appearance.

0:35

You can see a portion of it here.

0:36

And as you scroll through, it has

0:39

a very sort of unusual appearance.

0:41

There's certainly one portion of it

0:42

that you see up here, but there's

0:45

another portion of it you see down here.

0:47

And when you look at it on the coronal images,

0:50

on these images here, it almost looks like

0:53

they're two separate structures, and in fact,

0:56

indeed, there are two separate structures.

0:58

One gallbladder up here, and

1:00

another gallbladder down here.

1:02

And if you were to follow the gallbladders,

1:05

they will come together and will join right

1:08

over there into a single duct that then

1:12

drains into the common hepatic duct over here.

1:14

So I'm going to scroll through these coronal

1:16

images so you can kind of appreciate that

1:18

appearance of two gallbladders that eventually join

1:22

together and drain into the common hepatic duct.

1:26

And so this anatomic variant, this is very rare.

1:29

So one of the cases we talked about,

1:31

pharyngocap, that's very common.

1:33

That's something I hardly even comment on

1:35

sometimes, you know, because it's so common,

1:38

but this one definitely needs to be commented on.

1:39

This is a duplicated gallbladder.

1:41

You know, people have looked at this

1:42

in autopsy series and they say that

1:45

it's found about one in 4,000 adults.

1:47

I have to say I've never really seen many of

1:49

these cases, maybe one of the few cases I've seen.

1:52

And there are classification systems

1:54

that are out there that describe the

1:55

appearance of duplicated gallbladders.

1:58

Generally, you can have a bilobed

1:59

gallbladder with a single cystic duct.

2:03

You can have a complete gallbladder duplication

2:05

in which you have two cystic ducts, as

2:07

can be seen over here, that join together

2:10

to form into the common hepatic duct.

2:12

So you can think of it as having

2:14

sort of a Y configuration.

2:16

And you can have another variant where

2:18

you have a complete gallbladder duplication

2:20

where you have two cystic ducts that don't

2:22

join together, but rather enter the common

2:24

hepatic ducts separately at two separate points.

2:27

And so there are these variations.

2:28

All of these are very, very rare, but

2:30

it is important to know that they exist.

2:32

It's important to know how to describe them if

2:35

you do see them, because it has implications for

2:38

surgery should the patient have to undergo any

2:41

surgical procedure involving the gallbladder.