A Juillerat1, A-L Rougemont2, B E Wildhaber3. 1. Centre universitaire romand de chirurgie pédiatrique, service de chirurgie pédiatrique, département de pédiatrie, hôpitaux universitaires de Genève, rue Willy-Donzé 6, 1211 Genève 14, Suisse. 2. Service de pathologie clinique, département de médecine génétique et de laboratoire, hôpitaux universitaires de Genève, Genève, Suisse. 3. Centre universitaire romand de chirurgie pédiatrique, service de chirurgie pédiatrique, département de pédiatrie, hôpitaux universitaires de Genève, rue Willy-Donzé 6, 1211 Genève 14, Suisse. Electronic address: barbara.wildhaber@hcuge.ch.
Abstract
BACKGROUND: Gastrointestinal duplications are rare congenital malformations that can occur anywhere between the mouth and the anus, including the digestive annexes. Numerous classifications of these malformations exist, varying from one author to another. This study describes a rare case of gallbladder duplication and suggests a unified classification of gastrointestinal duplications in order to merge epidemiological and clinical considerations. CASE REPORT: A 13-year-old boy presented with acute abdominal pain. Investigations revealed a cystic structure located in the gallbladder combined with lithiasis. Following an elective laparoscopic cholecystectomy, the diagnosis of gallbladder duplication in association with heterotopic gastrointestinal mucosa and pancreatic micro-clusters was made. The patient is in excellent health 4 years after surgery. COMMENTARY AND CONCLUSION: This atypical duplication is rare and can most likely be explained by the proximity between the pancreas and gastrointestinal tract during their development: the intestinal metaplasia and the development of the gastric mucosa may further represent congenital lesions due to aberrant migration of normal tissue, or could be secondary to a chronic inflammatory response in the gallbladder. The revised standardized classification we propose is based on the accurate identification, precise location and detailed histology of the lesions.
BACKGROUND: Gastrointestinal duplications are rare congenital malformations that can occur anywhere between the mouth and the anus, including the digestive annexes. Numerous classifications of these malformations exist, varying from one author to another. This study describes a rare case of gallbladder duplication and suggests a unified classification of gastrointestinal duplications in order to merge epidemiological and clinical considerations. CASE REPORT: A 13-year-old boy presented with acute abdominal pain. Investigations revealed a cystic structure located in the gallbladder combined with lithiasis. Following an elective laparoscopic cholecystectomy, the diagnosis of gallbladder duplication in association with heterotopic gastrointestinal mucosa and pancreatic micro-clusters was made. The patient is in excellent health 4 years after surgery. COMMENTARY AND CONCLUSION: This atypical duplication is rare and can most likely be explained by the proximity between the pancreas and gastrointestinal tract during their development: the intestinal metaplasia and the development of the gastric mucosa may further represent congenital lesions due to aberrant migration of normal tissue, or could be secondary to a chronic inflammatory response in the gallbladder. The revised standardized classification we propose is based on the accurate identification, precise location and detailed histology of the lesions.