Acute cholecystitis in an intrahepatic duplicated gallbladder mimicking a liver abscess: The pivotal diagnostic role of percutaneous drainage

Gallbladder duplication is a rare congenital anomaly that poses significant diagnostic challenges, particularly when one moiety is intrahepatic. Herein, we report a case of acute cholecystitis in a 40-year-old man with a duplicated gallbladder that closely mimicked a liver abscess. Initial contrast-enhanced computed tomography revealed a rim-enhancing fluid collection in segment 4 of the liver, which was distinct from the normal gallbladder. Based on the intrahepatic location and signs of inflammation, a liver abscess was initially suspected. Ultrasound-guided percutaneous drainage was performed and unexpectedly yielded bile. Subsequent enhanced imaging with contrast injection through the drainage catheter revealed a communication between the cystic cavity and the common bile duct. Accordingly, the presumed lesion was determined to be an intrahepatic duplicated gallbladder. Magnetic resonance cholangiopancreatography confirmed the presence of a duplicated gallbladder of the trabecular type (Harlaftis classification). This case illustrates that intrahepatic duplicated gallbladders can closely mimic hepatic abscesses. In such diagnostic dilemmas, percutaneous drainage with contrast-enhanced imaging is a valuable tool for definitive anatomical mapping and guiding appropriate management.