A 39-year-old Asian female with known symptomatic gallstones was referred with a 2-month history of recurrent right upper abdominal pain that required Emergency Department admissions on two previous occasions, and an ultrasound of abdomen that showed multiple stones in a thin-walled GB with no biliary dilatation and no other abnormalities. There was a past medical history of spinal tuberculosis and caesarean section. Preoperative liver function tests were normal.
She also gave a 6-month history of constipation with associated weight loss and lower abdominal pain. We, therefore, arranged a non-contrast virtual computed tomography (CT) colonoscopy and this showed a structurally normal colon and confirmed calcified gallstones within the GB. However, the CT also demonstrated an unusual globular dense material within an unusual tubular structure located above and medial to the native GB with cross sectional dimensions of 37 mm x 11 mm. A subsequent magnetic resonance cholangiopancreatography (MRCP) demonstrated two separate thin-walled non-inflamed GBs with stones, which on T1 contained bile of varied density and signal characteristics between the two GBs (Fig. 1A & B), and with two distinct cystic ducts linking each GB separately to the biliary tree.
The patient subsequently underwent laparoscopic double cholecystectomy. Extensive right upper quadrant adhesions between the liver and diaphragm, as well as the GB, duodenum and transverse colon were divided. Twin GBs were identified within the GB fossa (Fig. 2), each had its own cystic duct and cystic artery. A stone was identified within the cystic duct of the superior GB (Fig. 3) and was extracted. Both cystic ducts were clipped and divided. The operating time was 145 min. There were no postoperative complications and the patient was discharged on the first postoperative day. Histology showed two thick walled (0.3 mm and 0.4 mm) GBs that contained stones; both had featured of chronic cholecystitis with no evidence of neoplasia. The patient remained symptom-free as far as the upper abdominal pain is concerned at 6 months follow up.