Confronting the uncommon: Cholecystitis and cholangitis in a young adult arising from a bilobed gallbladder with subvesicle duct - A case report and review of literature.

INTRODUCTION AND IMPORTANCE: Bilobed gallbladder is a rare congenital anomaly characterized by the duplication of the gallbladder. It presents a unique challenge for surgeons due to its infrequency and the potential for perioperative complications. Anatomical variations, including the presence of the subvesicle duct of Luschka, should be suspected in these cases. CASE PRESENTATION: In our case report, we present the clinical details of a **23-year-old male** who presented with symptoms of acute cholecystitis and cholangitis. Preoperative imaging revealed a bilobed gallbladder, and incidentally, intraoperative evidence of the subvesicle duct/duct of Luschka was also observed during a successful laparoscopic cholecystectomy. Importantly, the patient experienced no postoperative complications. CLINICAL DISCUSSION: This case highlights considering bilobed gallbladder as a differential diagnosis in patients with cholecystitis or cholangitis is crucial. Surgeons should be vigilant about this anomaly when evaluating patients with gallbladder-related symptoms. CONCLUSION: We understand precise imaging plays a pivotal role in guiding surgical planning. Detecting bilobed gallbladder preoperatively allows for better assessment of biliary structures and helps prevent bile leaks during surgery. Although rare, awareness of bilobed gallbladder and its associated anatomical variants is essential for optimal patient management and successful surgical outcomes. Surgeons should remain attentive to such anomalies to ensure safe and effective procedures.

Palmoplantar Plaque Psoriasis is Associated with Diabetes, Hypertension, Obesity, and Metabolic Syndrome-A Case-Control Study.

Background: Palmoplantar plaque psoriasis is a regional variant of psoriasis, characterized by erythematous, indurated plaques with fissuring over palms and soles. Chronic plaque psoriasis is associated with various comorbidities such as obesity, diabetes mellitus, hypertension, dyslipidemia, metabolic syndrome, and cardiovascular disease. Body surface area involvement is an indicator of psoriasis severity, and most comorbidities are more strongly correlated with severe disease. Objectives: To estimate the prevalence of metabolic comorbidities in palmoplantar plaque psoriasis. Methods: It is a case-control study involving treatment naïve palmoplantar plaque psoriasis patients and age- and gender-matched healthy controls. Results: The study included 100 cases and 100 controls. The mean age among cases and controls was 45.4 ± 11.1 and 43.9 ± 10.3 years, respectively (P: 0.31). The gender ratio among cases and controls was 1.56 (61M: 39F) and 1.94 (66M: 34F), respectively. Comorbidities including metabolic syndrome (P: 0.001), obesity (P: 0.001), diabetes mellitus (P: 0.001), and hypertension (P: 0.001) were more common among cases as compared to controls. The odds of diabetes, metabolic syndrome, hypertension, and obesity in patients with palmoplantar psoriasis were 4.8 (95% CI 2.5-9.3), 3.7 (95% CI 2-6.9), 3.1 (95% CI 1.6-6), and 3.5 (95% CI 1.9-6.4), respectively. Conclusion: In this study, we found that palmoplantar plaque psoriasis is associated with metabolic comorbidities. Primary care physicians should screen patients with palmoplantar psoriasis for these comorbidities.