Type IVA choledochal cyst with gallbladder duplication: a case report

Gallbladder duplication is a rare congenital anomaly, and its coexistence with choledochal cysts is exceptionally uncommon. A 7-year-old female presented with recurrent right upper quadrant abdominal pain over several months. Laboratory investigations revealed elevated serum AST (142 IU/L) (normal range 8-33 IU/L) and ALT (158 IU/L) (normal range 4-36 IU/L), with mildly raised alkaline phosphatase; bilirubin levels were within normal limits. Abdominal ultrasonography (USG) demonstrated common bile duct dilation, and Magnetic Resonance Cholangiopancreatography (MRCP) confirmed a Type IVA choledochal cyst. Laparoscopic excision of the cyst with hepaticoduodenostomy was planned. Intraoperatively, a V shaped duplicated intrahepatic bilobed gallbladder was discovered, with a single cystic artery and a single cystic duct (bifurcated high up distally to drain the duplicated lobes of gall bladder) draining into the common bile duct. Both gallbladders were excised, and a hepaticoduodenostomy was performed. Histopathology confirmed gallbladder duplication with chronic inflammatory changes and no dysplasia. Gallbladder duplication is a rare congenital anomaly that may not be identified on preoperative imaging, particularly in the setting of complex biliary anomalies like choledochal cyst.