Double Gall Bladders in Man: A Case Report

The frequency of surgical exposure of the bile ducts and gall bladder has made the surgeon increasingly aware of the anatomic variations in these structures and their blood supply. The double gall bladder in man is a rare anomaly. Of the 103 previous reports of double gall bladders that are available to the author, only 68 occurrences of this anomaly were actually proved at operation or autopsy.""' Since cholecystography was introduced by Graham and Cole in 1924, 44 cases have been detected radio-graphically; however, only 9 (of these) were actually confirmed by anatomical examination." It was stated in one article in which 36 cases were reviewed that 27 of these were reported by surgeons.' The nine remaining cases were autopsy and dissecting room observations. A few cases have been reported where the diagnosis was made by x-ray but was not confirmed by operative exposure. In one of these a congenitally folded gall bladder simulated a double gall bladder by cholecystography.' The standard textbooks of anatomy and surgery rarely mention anomalies of the biliary tract, despite the considerable number of case reports and reviews.7"9'13 As many as 47.25 per cent of patients requiring biliary surgery demonstrated deviations from the "normal" biliary tract anatomy described in textbooks.10 Similarly, the "normal" anatomy of cystic and hepatic arteries was present in only 32.0 per cent of 200 cases at surgery.8 The earliest available records of gall bladder anomalies in animals appeared in the cuneiform writings of the Babylonian civilization dealing with religious symbolism.'" Pliny described a double gall bladder in an animal sacrificed in 31 B.C. during the celebration of Augustus Caesar's victory over Antony and Cleopatra. During the ninth century A.D. Joseph Caro's "Shulhan Aruch," the authoritative codification of Jewish dietary laws, mentioned nine specific rules concerning animals possessing duplication of the gall bladder which rendered such meat unfit for human consumption.' Anomalous gall bladders are more common in animals than man.' Dissec-tion of 10,000 animals revealed 23 duplications of the gall bladder in 2,600 * Fourth-year medical student; Chief Prosector in Anatomy.