S3572 Right Upper Quadrant Pain in Young Female With Duplicated Biliary System

Introduction: Extrahepatic biliary duplication is a rare congenital anomaly that can present at any time in life with varying degrees of symptoms. Below we present a case of duplicated gallbladder and common bile duct in a young woman who presented with right upper quadrant pain. Case Description/Methods: Twenty-three-year-old woman with no past medical history who presented to her primary care physician with right upper quadrant pain. All laboratory results including alanine aminotransferase and aspartate aminotransferase, bilirubin and alkaline phosphatase were all within normal range. Given suspicion for biliary process despite normal laboratory values, patient was sent for a magnetic retrograde cholangiopancreatography (MRCP). MRCP was significant for apparent duplication of the gallbladder and common bile duct. Further workup with nuclear medicine HIDA scan was significant for a post-cholecystokinin gallbladder ejection fraction of 92%, which is consistent with biliary hyperkinesia. Given her high risk of symptom recurrence, patient has been referred to general surgery consultation for elective cholecystectomy; however she has decided to defer surgery at this time. Discussion: Duplication of the biliary tree has several different anatomical variations including bilobed (common neck) ranging to full duplication of the gallbladder and entire biliary tree. While many patients remain asymptomatic, many present with symptoms such as nausea, vomiting and right upper quadrant pain. These patients generally go to surgery which proves to be rather complex given the duplicated system usually which is not discovered until the patient is in surgery. One study found that nearly 80% of patients with duplicated biliary system are diagnosed intraoperatively. This poses a unique surgical conundrum; and with no clear guidance, systems or classifications, poses a risk to both diagnosis and treatment. In this case, this patient presented with symptoms of biliary colic and was incidentally discovered to have these findings. Although MRCP is convincing, the HIDA scan only showed biliary hyperkinesis. It is important for this patient to have surgical planning to ensure safe extraction of both gallbladders to avoid complications such as cholecystitis, choledocholithiasis or cholangitis.