Septum of gallbladder is a rare entity.[3] The etiology of septum of gallbladder is obscure, being mostly congenital in origin. This is suggested to be formed by aberrations leading incomplete resolution of solid stage in its development around the third month of fetal embryogenesis.[4]Rarely, post inflammatory adhesions and compartmentalization leads to formation of septate gallbladder.[ 5] Furthermore literature report a female preponderance of this anomaly [6]
The septum gallbladder is mostly single but multiseptate gallbladder have also been reported. [7]]Plane of septum is either longitudinal called as bilobed gallbladder or in transverse plane called as Hour glass gallbladder [8, 9] Septum of gallbladder may be complete or incomplete. These septum may contain smooth muscle fibers usually divides the gallbladder into two chambers.[10] The septum may be communicating or non-communicating and communication between two cavities is via small opening. [11]
Inflammation of gallbladder may be solely seen in either of the compartment or both. There is increased prevalence of formation of gallstones in septate gallbladder than in unseptated one.[12 ] The pinpoint communication between the cavities causes stasis of secretions inside these two cavities in septate gallbladder Bile stasis secondary to gallbladder septation is possibly incriminated as the predisposing factor for cholelithiasis. Gallstones may be form in one of the cavities or both. Rarely, acalcolus cholecystiytis may be seen in septate gallbladder.[6]Sometimes there may be associated anomalies with septate gallbladder like choledochal cyst or accessory hepatic duct.
Septate gall bladder is a congenital anomaly which is rarely reported, as they are usually asymptomatic and are found as a part of an evaluation for recurrent abdominal pain or rarely as a cause for jaundice [13]This rare anomaly usually has an asymptomatic course and is diagnosed as an incidental finding without any clinical relevance.[14 ] Rarely, however, septate gallbladder may cause recurrent attacks of abdominal pain [15 ] Symptoms are usually caused by pressure in the small chambers of the gallbladder along with delayed emptying which may sometimes deem early cholecystectomy.[11]
Misdiagnosis often leads to an unnecessary prolongation of the interval between diagnosis and operative treatment. Ultrasonography, computed tomography scan, 99mTcIDA scintigraphy, endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography are confirmatory in diagnosis.[16] An expert radiologist may pick up septate gallbladder preoperatively while searching for cholelithiasis MRCP makes diagnosis early and definite preventing possible complications
Sometimes it can be misdiagnosed as choledochal cyst or leads pitfalls at ultrasound imaging, causing a false-positive diagnosis of gallstones.[13]
Intraoperatively, in laparoscopic cholecystectomy, septate gallbladder may be diagnosed while retrieving calculi from gallbladder for decompression to pass through epigastric port .Empty scoops from one of compartment in bilobed gallbladder points to diagnosis. Grossly, may be diagnosed by inspection of specimen. There is no treatment requirement for septate gallbladder unless associated with gallstone, recurrent abdominal pain, adenomyomatosis, cholesterosis or acalcolus cholecystitis