A REVIEW OF ANATOMICAL VARIATIONS OF THE NUMBER OF GALLBLADDER
By
Tarek Essa1; Mohamed Hindawy1; Manal Mohamed Hatem1; Elmuataz E.A. Mohammed2; Mohamed F. Lutfi2; Nagwa E.I. El Amin3; Khawaja Shahid Rafi3; Attia M. Gabr4
1 Department of Anatomy and Histology, College of Medicine, Qassim University, Saudi Arabia.
2 Department of Physiology, College of Medicine, Qassim University, Saudi Arabia.
3 Department of Biology and Immunology, College of Medicine, Qassim University, Saudi Arabia.
4Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Saudi Arabia.
Multiple gallbladders (MGB) represent a rare congenital anomaly arising from disrupted embryological development of the pars cystica between the 5th and 8th gestational weeks. With an estimated incidence of 1 in 4,000 births, MGB is often asymptomatic but poses significant clinical challenges when complications like cholecystitis or gallstones arise. This review synthesizes literature (1990–2024) to elucidate MGB’s embryology, anatomical classifications, diagnostic approaches, and surgical management. Key anatomical frameworks include the Harlaftis classification—categorizing MGB into types based on embryological origin (single vs. multiple cystic primordia) and cystic duct anatomy—and Boyden’s system, distinguishing bilobed (vesica divisa) from true duplication (vesica duplex). Type 2 ductular MGB (separate cystic ducts) is most prevalent (36–50%), while triple gallbladders remain exceptionally rare. Diagnostically, ultrasound is often the initial modality but lacks sensitivity; magnetic resonance cholangiopancreatography (MRCP) emerges as the gold standard for precise preoperative evaluation. Surgical management mandates concurrent removal of both gallbladders if pathology is present, preventing recurrent complications. Prophylactic excision is advised for Type II anomalies mimicking high-risk biliary diverticula. Despite low malignancy risk, intraoperative anatomical clarity is critical to avoid bile duct injuries or incomplete resection. Advancements in MRCP with 3D reconstruction enhance preoperative recognition, reducing intraoperative risks. Clinician awareness of MGB’s variants, guided by embryologically informed classifications, is vital for optimal outcomes. This review underscores the necessity of integrating advanced imaging and anatomical knowledge into surgical planning to mitigate morbidity in this rare yet clinically significant anomaly.
December 2024