Laparoscopic treatment of gall bladder duplication

True gall bladder duplication having separate cystic duct insertions into the common hepatic duct [CHD] is an extremely rare anomaly. Frequently the diagnosis is not made preoperatively. There have been many case reports of the second gall bladder being missed at laparoscopic cholecystectomy and subsequently requiring a second cholecystectomy later. Moreover, it is challenging to delineate the altered anatomy in order to avoid CHD injury. We report a case of true duplication of the gall bladder successfully managed laparoscopically. The limitations of diagnostic modalities and current strategy of management are discussed

Management of high spinal injury: an anaesthetic riddle

Cord injured patients pose unique difficulties, autonomic dysreflexia merits special concern. A sixty six years old female patient with a history of compressive myelopathy at the level of T1-T2 was placed for anterolateral decompression under general anaesthesia. During intraoperative period the patient developed several episodes of bradycardia and hypertension. Towards the end of surgery she developed hypothermia and hypotension needing the support of vasopressors. On the 3rd postoperative day she developed left sided collapse of the lung, which responded to chest physiotherapy and mucolytics. This case report demonstrates several issues confronting the anaesthetist while dealing with patients of high spinal cord lesion. An adequate knowledge and quick anticipation of complications can however avert a major disaster