Abdominal Pain Caused by a Second Gall Bladder and Separate Cystic Duct

A 35-year-old morbidly obese (body mass index, 40) woman presented with a few months of postprandial right upper-quadrant pain, nausea, and vomiting. Physical examination was positive for Murphy's sign, but otherwise unremarkable. Her laboratory values including liver chemistry were normal except for a mildly increased white count. Initial work-up with an abdominal ultrasound showed an intrahepatic cyst in addition to the gallbladder. Magnetic resonance cholangiopancreatography (Figure A) and subsequent endoscopic retrograde cholangiopancreatography performed for clarification showed the presence of a cyst with a separate duct draining into the common hepatic duct.

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