OhioHealth Riverside Methodist Hospital Columbus, OH, United States
Award: Presidential Poster Award
Ellen Tan, DO, Peter Hopmann, MD, David Y. Lo, MD OhioHealth Riverside Methodist Hospital, Columbus, OH
Introduction: Common diagnoses associated with right upper quadrant (RUQ) pain include cholecystitis, peptic ulcer disease (PUD), biliary colic, and irritable bowel syndrome (IBS). Multiseptate gallbladder is a rare congenital anomaly that can prolong definitive diagnosis and treatment. We present a case of multiseptate gallbladder with symptom resolution after cholecystectomy.
Case Description/Methods: A 21-year-old female presented with intermittent RUQ abdominal pain and postprandial epigastric discomfort associated with nausea and vomiting. She was treated empirically for reflux and IBS without complete improvement. Labs revealed normal hemoglobin and liver function tests. EGD was negative for PUD and celiac disease. RUQ ultrasound showed a gallbladder with numerous septations (Figure 1), without stones or biliary ductal dilatation. Given persistent symptoms, laparoscopic cholecystectomy was performed. Gross examination of the gallbladder showed multiple septations without stones. Pathology revealed chronic cholecystitis. In four months of follow up, the patient has been free of symptoms.
Discussion: Multiseptate gallbladder is a rare congenital anomaly most commonly presenting with recurrent RUQ abdominal pain, biliary colic, nausea, and vomiting. There is a female predominance with this condition, with a mean age of diagnosis of approximately 29 years. Multi-septations are thought to result from incomplete cavitation of the developing gallbladder bud and wrinkling of the gallbladder wall. It is postulated that the septa cause difficulty in passage of bile and uncoordinated contractions leading to stasis and incomplete emptying, which can explain symptoms of biliary colic. Diagnosis is usually made on transabdominal ultrasound. Other imaging methods include computed tomography, magnetic resonance imaging, endoscopic retrograde cholangiography, and endoscopic ultrasound. Diagnosis is often delayed due to the rarity of multi-septate gallbladder. One should have a high suspicion if patients have persistent symptoms refractory to treatment. Documented associations include cholelithiasis, cholecystitis, choledochal cyst, gallbladder hypoplasia, phrygian cap, and pancreaticobiliary junction. Cholecystectomy is treatment of choice to alleviate recurrent gastrointestinal symptoms.
Figure: Ultrasound imaging of the gallbladder showing multiple septations resembling a “sack of grapes” appearance.
Disclosures:
Ellen Tan indicated no relevant financial relationships.
Peter Hopmann indicated no relevant financial relationships.
David Lo indicated no relevant financial relationships.
Ellen Tan, DO, Peter Hopmann, MD, David Y. Lo, MD. P1119 - Multiseptate Gallbladder Presenting With Biliary Colic, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
