ABSTRACT
INTRODUCTION: Gallbladder duplication is a rare congenital anomaly of the biliary tree. Although a double gallbladder by itself is not clinically significant, complications of gallstone disease increases the complexity of the management. Preoperative recognition decreases the risk of complications during laparoscopic cholecystectomy. PRESENTATION OF CASE: Presented herein is the case of a 52 year old who presented with abdominal pain. A transabdominal ultrasound was suggestive of a gallbladder duplication with the larger gallbladder filled with cholelithiasis. Subsequent imaging studies, including an endoluminal ultrasound, confirmed the diagnosis and documented a choledocholithiasis. Endoscopic extraction of the biliary stone with subsequent laparoscopic cholecystectomy of both gallbladders was successfully performed. DISCUSSION: This case is being presented not only for the rarity of the condition but also of the challenges in management it poses. In gallbladder duplication, pathologic involvement of one gallbladder requires removal of both gallbladders. A high index of suspicion on initial scanning warrants further delineation of the important anatomic structures of the biliary tree to avoid perioperative complications. CONCLUSION: Laparoscopic cholecystectomy may be safely performed in patients with gallbladder duplication. Preoperative recognition with appropriate imaging modalities, including ultrasound and MRCP may avoid surgical complications. In cases where the anomaly is detected intraoperatively during cholecystectomy, meticulous dissection and intraoperative cholangiography will avoid iatrogenic injuries and lead to successful outcomes.
ABSTRACT
Currently, the in-vitro method has been recognized as the valid gold standard for Nuclear Medicine. However, bloodletting is necessary in the use of this method and cold be very traumatic, most especially for pediatric patients. The Inoue method bypasses this trauma by omitting the need to withdraw blood. The study consisted of 36 patients ranging from ages 2 months to 19 years old. The subjects used were those who were previously subjected to in-vitro method. The scintigrams of the in-vitro method would be obtained and processed for split percentage uptake and for parameters needed to obtain Inoue GFR. The first set of data for total percentage uptakes versus normalized in-vitro GFR obtained are observed that percent renal uptakes are proportional to in-vitro GFR. The main data set of this paper of this paper, correlates the Inoue GFR and the reference method (in-vitro method), which has a significantly strong correlation (r=0.926). Thus, Inoue method is a viable, simple, and practical technique in determining GFR in pediatric patients, since it yields a precise value as the clinical gold standard.
