The American Journal of Medical Sciences and Pharmaceutical Research
14
https://www.theamericanjournals.com/index.php/tajmspr
TYPE
Original Research
PAGE NO.
14-19
10.37547/tajmspr/Volume07Issue05-03
OPEN ACCESS
SUBMITED
22 January 2025
ACCEPTED
25 February 2025
PUBLISHED
07 May 2025
VOLUME
Vol.07 Issue 05 2025
CITATION
Wander Costa Matos, Luiz Guilherme Oliveira Fontoura, Luena Braz de
Novais Neves Rak, & Murillo de Sousa Pinto. (2025). ALVEOLAR BILIARY
VESICULAR: A Case Report on a Rare Anatomical Variation. The American
Journal of Medical Sciences and Pharmaceutical Research, 7(05), 14
–
19.
https://doi.org/10.37547/tajmspr/Volume07Issue05-03
COPYRIGHT
© 2025 Original content from this work may be used under the terms
of the creative commons attributes 4.0 License.
ALVEOLAR BILIARY
VESICULAR: A Case Report
on A Rare Anatomical
Variation
Wander Costa Matos
1
, Luiz Guilherme Oliveira
Fontoura
2
, Luena Braz de Novais Neves Rak
3
,
Murillo de Sousa Pinto
4
¹Radiologist Doctor from Universidad Cristiana de Bolivia, Bolivia.
²Medical student from Centro Universitário Alfredo Nasser, Goiânia,
74905-020, Brasil.
³Feloy in interna medicine from Centro de Reabilitação e
Readaptação, Goiânia, 74653-230, Brasil.
4
Graduate Program in Health Assistance and Evaluation, Federal
University of Goiás, Goiânia,74605-010, Brazil; Institute of Health
Sciences, Alfredo Nasser University Center, Goiânia, Goiás, Brazil.
Abstract:
Multiseptate gallbladder is a congenital
alteration in the formation of this organ, resulting in
septa in the lumen of the gallbladder. Cases of patients
with this condition is quite rare in the world database,
which means that the amount of papers published on
this subject can be hard to find and in a few numbers.
These conditions usually do not lead to symptoms in
which a patient can live the entire life without a
diagnosis; however, some patients may present an
association with another pathology, especially in the
abdominal region, which leads to an evaluation of the
gallbladder and diagnosis of this septa. The main ways
to diagnose this condition are through imaging tests,
such as ultrasonography and computed tomography,
which allow the perception of the wall, volume,
consistence and lumen of this organ. Therefore, the
present case report presents a picture of an
asymptomatic patient diagnosed with multiseptate
gallbladder. In addition, a review of the literature on
the similar case reports presents in databases such as
PubMed is included. Applying the knowledge acquired
from the literature found it’s possible to understand
that this condition occurs because of an alteration on
the process that forms the gallbladder and it can
manifest with symptoms or it can stay asymptomatic
and just be found by accident. When this condition
The American Journal of Medical Sciences and Pharmaceutical Research
15
https://www.theamericanjournals.com/index.php/tajmspr
The American Journal of Medical Sciences and Pharmaceutical Research
creates symptoms, the patient may need to go through
a surgical procedure, like a cholecystectomy, but its
only necessary in the presence of manifestations,
otherwise, the patient can live a normal life with
treating this alteration.
Keywords:
Multiseptate gallbladder. Honeycomb
gallbladder. Anatomic variation. Case report.
INTRODUCTION:
The multiseptate gallbladder, also known as
"honeycomb gallbladder," is a rare congenital condition
characterized by multiple septa within the gallbladder,
dividing its lumen into smaller compartments of varying
sizes. The first reported case dates back to 1963 and
involved a pediatric patient. Since then, only a limited
number of cases have been identified worldwide. This
condition can mimic other gallbladder pathologies,
presenting
either
symptomatically
or
asymptomatically. Asymptomatic cases pose greater
diagnostic challenges and are often diagnosed later in
life (Amgad et al. 2024).
Worldwide, there is less than 150 case reports of
patients with the same condition. Initially the reports
were sporadically, but later, with the usage of image
exams for diagnosis, more cases could be found and
described within recent decades. The study made from
Terkawi, 2021 analysed 97 case reports observed that
patients could be identify from all ages and sex. The age
gap observed were was over 84 years, being the
youngest patient with 9 months and the oldest was 84
years old. This shows that the identification of a
multiseptate gallbladder case can be found in any
patient and that people can live a long time with
suffering any symptom (Terkawi, 2021).
From the initial reports on the rare congenital anomaly
around the mid-20th century, multiseptate gallbladder
has become a more frequently study subject compares
to the firsts cases reported. This condition has the
specific and unique characteristic of multiple thin walls
inside the gallbladder, called septa, that are fused to
the inner wall of this organ, which results in a distinctive
appearance of a honeycomb. This rare condition is
described in very few patients over the world and the
physiological mechanism behind the development of
the septa still very unclear to this day, but some
theories have been published. In addition, this
anatomic variation divides the patients into two
groups, symptomatic and asymptomatic, but it is
generally associated with a benign anatomical variation
(González et al., 2023).
Symptomatic patients typically report upper abdominal
pain and other hepatobiliary symptoms. Multiseptate
gallbladders can be further characterized by anatomical
variations in size, shape, position, and the number of
septa. Despite the variety of nonspecific clinical
manifestations, the absence of reported malignancies
suggests that this anatomical variation is benign (Hsieh
et al. 2021).
It is very common that the diagnosis of this condition
occurs bay incident. This means that, normally, a
patient presenter some condition unrelated to the
gallbladder and by an evaluation, there is the diagnosis
of the multiseptate gallbladder. This can be seen in
many case reports publish and it show that the finding
of this condition can be difficult, therefore rare. In
addition, this also presents that most patients can be
asymptomatic for the biliary alteration. This does not
mean that all people with this condition will not present
some kind manifestation, it means that, normally, the
symptoms that a person will present, might not be
related to this anatomic variation. This can justify the
fact that some patients can present abdominal
manifestations, like abdominal pain, but it frequently
associated with other conditions, like cholecystitis, and
after a intervention, for example, a cholecystectomy,
the multiseptate gallbladder can be find and diagnosed
(Desai, Gianchandani, 2023).
The manifestations behind patients with a multiseptate
gallbladder creates two groups. People with symptoms
that can directly relate to this anatomic variation are
call symptomatic and patients that presents similar
characteristics but does not present symptoms are
called asymptomatic. The cases that are not related to
a manifestation related to the honeycomb gallbladder
can be difficult to be diagnose and are frequently found
be accident in the routine’s examinations. The main
way to diagnose the patients that presents this
variation is by imaging examination which, normally,
are made after a susception of cholecystitis, for
example (Hopmann, 2022).
The exact pathophysiology of multiseptate gallbladder
development remains unclear, but several theories
exist. A leading hypothesis suggests a defect in early
embryological maturation, specifically an anomaly in
gallbladder development resulting in incomplete
vacuolization of the vesicular lumen. Another theory
proposes a defect in vesicle folding associated with
vesicular growth outpacing lumen development (Faraj
et al., 2024).
The objective of this study is to describe the findings
involving a patient that has a multiseptate gallbladder.
In addition, compare this report with the papers publish
The American Journal of Medical Sciences and Pharmaceutical Research
16
https://www.theamericanjournals.com/index.php/tajmspr
The American Journal of Medical Sciences and Pharmaceutical Research
on PubMed and discuss about this rare anatomical
variation in the gallbladder. It’s expected that the
multiseptate gallbladder can be consider a rare
condition and it may or may not be associated with a
pathological process or it can be developed without a
disease.
MATERIALS AND METHODS
This study is a case report was caried out through
clinical care and medical follow-up that happened for
one year, of a patient with a rare anatomical variation
in the gallbladder, that later was define as multiseptate
gallbladder. The patient was admitted by doctor
Wander Costa Matos in his office for a routine
consultation, when he presented abdominal pain
creating the need for an image evaluation, therefor, an
ultrasonography was recommended. The results
showed a multiseptate gallbladder. To this end, the
question formulated to justify this case report was: "Is
there scientific evidence on anatomical variations of
alveolar gallbladder and its impact on health?", Soon
after, a search was carried out in the Medical Literature
Analysis
and
Retrieval
System
online
(MEDLINE/PubMed), Latin American Literature in
Health Sciences (LILACS), SCIELO (Scientific Electronic
Library Online), to sustain the discussion of this work
using scientific articles published in full that addressed
the main theme. There were 9 references selected to
sustain the findings of the study. The papers were
selected by the following criteria: published in the past
5 years and the use of “Multiseptate gallbladder”
keyword. The reference that was excluded involved
patients that had other conditions that influenced in
their health and necessity or interventions.
RESULTS
The patient, a 64-year-old male patient, retired, arrived
at the office for routine exams, denying symptoms or
previous history of surgeries. He performs similar tests
annually due to the presence of metabolic syndrome.
The patient is hypertensive controlled on captopril
25mg, twice a day. He is overweight, according to his
BMI of 27. He also has mild hepatic steatosis. He denies
diabetes or insulin resistance, alcoholism and smoking.
During the targeted anamnesis, he reported absence of
jaundice throughout his life, abdominal pain, choluria
or fecal acholia. He also describes never having
undergone
surgical
procedures
or
previous
hospitalizations worthy of note.
On May 20, 2024, at the hospital in Nova Veneza
–
Goiás, the patient underwent a total abdominal
ultrasound. The results of the examination are shown
below (Figures 01 and 02).
Figure 01: Longitudinal section of the gallbladder.
Legend: Gallbladder section in longitudinal pattern. The presence of several complete and thin septations
occupying the interior of the gallbladder is observed. Source: author, 2024.
The American Journal of Medical Sciences and Pharmaceutical Research
17
https://www.theamericanjournals.com/index.php/tajmspr
The American Journal of Medical Sciences and Pharmaceutical Research
Figure 02: Cross-section of the gallbladder.
Legend: Gallbladder section in a cross-sectional pattern. Presence of incomplete septation within the
gallbladder lumen. Source: author, 2024.
It is noted that a topical, normodistended gallbladder
has anichogenic content, well-defined contours, thin
walls, but with the presence of multiple complete and
incomplete septations that communicate the internal
walls of the gallbladder. Dimensions: 6.2 x 3.1 x 3.4 cm
- (Long x AP x T). The wall thickness measures 1.6 mm.
In addition, additional findings were found from the
examination, which consists of simple bilateral renal
cysts and mild hepatic steatosis.
The patient's last evaluation was in February 2024 and
the patient is currently asymptomatic, with no
laboratory abnormalities.
In view of the situation, the physician in charge took the
case for discussion among the health professionals
responsible for the patient, after conducting searches
in the main databases, such as PubMed, based on
images and similar conditions, the definition of a
multiseptate gallbladder condition was concluded.
DISCUSSION
The incidence of multiseptate gallbladder reported in
health databases is low. For example, approximately 65
papers were published between 1964 and 2025, with
only 9 publications in the PubMed database in the past
5 years. Therefore, multiseptate gallbladder is
considered a rare congenital condition characterized by
multiple septa within the gallbladder's inner wall,
dividing its internal space into smaller compartments of
varying sizes. The first case was described in 1963, and
few cases have been reported since, possibly because
the anatomical variation is often asymptomatic (Amgad
et al. 2024).
Multiseptate gallbladder is a relatively recent discovery
in the medical field, with most case reports appearing
after the 1900s. To date, few cases have been reported
worldwide,
and
the
underlying
physiological
mechanisms remain unclear. Due to the lack of
associated pathological manifestations, multiseptate
gallbladder is considered a rare, benign anatomical
variation characterized by multiple septal membranes
in the gallbladder lumen, creating a honeycomb
appearance (González et al., 2023).
Explaining how the gallbladder is the develop in to the
multiseptate form can be a seeing as a challenge for the
medical field, but some theories were created along the
years.
Around
1970,
Bhagavan
created
the
embryological hypothesis and he proposed that, in the
latest embryological states, there is a failure in the
process of disappearing the septa that exists in the
inside of the gallbladder. With that process, the inner
walls then fuse forming locules that creates spaces in
the lumen that are separated by the thin septa, which
characterise the condition (Terkawi, 2021).
The American Journal of Medical Sciences and Pharmaceutical Research
18
https://www.theamericanjournals.com/index.php/tajmspr
The American Journal of Medical Sciences and Pharmaceutical Research
The diagnosis of multiseptated gallbladder usually
happens unintentionally, since most patients who have
this anatomical variation do not have symptoms
directly related to this condition. In this sense, patients
present with other complaints and pathological
conditions and changes in the gallbladder are
eventually identified. This can be observed, for
example, in the case of the patient who presented to
the health service with abdominal pain and symptoms
characteristic of cholecystitis. After biochemical
examinations, other pathologies originating in the liver
or
blood
were
excluded,
and
abdominal
ultrasonography defined the diagnosis of cholecystitis,
but without any apparent anatomical alteration
described in the report. The patient was treated with a
cholecystectomy with improvement of cholecystitis,
however, after an evaluation of her gallbladder, septa
were found in the lumen of the organ, thus
characterizing a multiseptated gallbladder (Desai,
Gianchandani, 2023).
In view of the frequent asymptomatic condition, most
patients diagnosed with this condition presented
themselves for another evaluation. In this sense, it is
possible to identify two types of patients, those who do
not have any type of symptom and, therefore, are
diagnosed in routine exams, for example, and those
who have some sign or symptom, especially in the
abdominal region. In this case, it is possible to identify
that the abdominal pain characteristic of biliary colic is
recurrent. Therefore, imaging tests such as ultrasound
and computed tomography are used for a more
detailed evaluation, leading to the identification of this
anatomical variation. Even so, there are patients who
do not have changes in imaging tests and are only
identified after a cholecystectomy, for example
(Hopmann, 2022).
The reason around the use of imagen’s test to find the
variation due to the diseases that are frequently
associated to the patient’s medical history. The main
diseases that are presented by the patients are biliary
complications such as cholecystitis, cholelithiasis and
congenital biliary dilation that causes abdominal pain.
This pain makes the patient seek medical attention and
the necessity for the image examination. The finding of
multiseptate gallbladder associated of a pathological
condition of the gallbladder creates the necessity of a
medical intervention. In this case, mainly, surgical
procedures are indicated to resolve the pathology,
even though the anatomical variation does create the
necessity for the procedure (Oyachi et al., 2022).
Normally, the ultrasonographic imaging show the
gallbladder with multiple septa and this can be
described as multiple linear structures crossing the
gallbladder from one internal wall connecting to
another point inside the organ, similar to a honeycomb.
Septa can be can be seen as smooth and thin tissue that
is similar to the inner wall of the gallbladder. They can
be seen in different forms of imaging examination, such
as CT and MRI, where the inside of the organ shows a
heterogeneous signal intensity. When a disease
happens, the septa can suffer inflammation and the
image characteristics changes, becoming more intense
due to a higher intensity signal, for example. The
understanding of this alteration is important to define
the treatment plan, because it determines when a
intervention is appropriate and avoids misdiagnoses,
for example (Ichikawa et al., 2021).
The study by Amgad et al. (2024), presents a rare case
of multiseptated gallbladder (MSG) in a 4-year-old
pediatric patient, who complained of persistent colicky
abdominal pain for three months. MSG is a congenital
anomaly characterized by the presence of internal
septa that divide the gallbladder into multiple
compartments, which can make diagnosis and clinical
management difficult. The patient was diagnosed
through ultrasonography and magnetic resonance
imaging, which showed MSG with bile sludge, but
without stones. Despite normal initial laboratory
results, the decision for laparoscopic cholecystectomy
was made due to the persistence of symptoms,
resulting in a complete recovery without complications
over six months. The article highlights the scarcity of
cases in the literature, with 37 pediatric cases reviewed,
predominantly in girls, and emphasizes the importance
of imaging techniques for accurate diagnosis. Although
many cases are asymptomatic and can be managed
conservatively, surgical intervention is recommended
for those with persistent symptoms.
Another case report that presents a similar finding is
from a 5 years old girl that present acute abdominal
pain and it was admitted at the emergency service for
further investigation. In the abdominal evaluation, she
presented fever and sensitivity for pain in the right iliac
fossa. These manifestations are characteristic of
inflammation of the appendix and that creates the
necessity of sonographic analysis. The image
examination, the diagnosis was confirmed and it was
possible to identify multiple septa on the biliary
gallbladder. This is another example of how the
multipleseptate gallbladder is investigated and
diagnosed in an asymptomatic patient, but it’s
important to understand that some patients will
present manifestation (Faraj et al., 2024).
CONCLUSION
The American Journal of Medical Sciences and Pharmaceutical Research
19
https://www.theamericanjournals.com/index.php/tajmspr
The American Journal of Medical Sciences and Pharmaceutical Research
The multiseptated gallbladder is a congenital
anatomical variation that usually does not have specific
symptoms, so its diagnosis can be complex. Patients
who present this alteration in the formation of the
gallbladder may never present symptoms and
therefore are identified when they undergo routine
exams, such as the patient presented, or they may
present manifestations of other abdominal diseases, so
they seek assistance from health services and are then
diagnosed with the septate gallbladder. In this sense, it
is observed that when patients present some form of
clinical manifestation, there is a high frequency of
abdominal symptoms, such as abdominal pain
characteristic of biliary colic. That said, the main
imaging tests used in this diagnosis are ultrasonography
and computed tomography. These tests allow the
identification of changes in the wall, volume and lumen
of the gallbladder leading to the diagnosis. In addition,
cholecystectomy can also be a form of diagnosis in
some patients.
REFERENCES
AMGAD, A.
et al.
Multiseptate gallbladder in a pediatric
pateint: A case report and review of literature.
International Journal of Surgery Case Reports
, v. 123,
2024.
Disponível
em:
https://pubmed.ncbi.nlm.nih.gov/39303484/
DESAI,
K.,
GIANCHANDANI,
S.
Multi-Septate
Gallbladder in a Patient With Acute Cholecystits.
Cureus
, v. 15, n. 10, p. 1-5, 2023. Disponível em:
https://pmc.ncbi.nlm.nih.gov/articles/PMC10632181/
pdf/cureus-0015-00000046762.pdf
FARAJ
et al
. Multiseptate Gallbladder in an
Asymptomatic Child: Case Report and Review of the
Literature.
Radiol. Case Rep.
, v. 19, n. 4, p. 1401-1403,
2024.
Disponível
em:
https://pmc.ncbi.nlm.nih.gov/articles/PMC10803780/
GONZÁLES, L. O.
et al.
Multiseptate gallbladder in
pediatric patient.
Aten. Primaira
, v. 55, n. 12, p. 1-3,
2023.
Available
in:
https://pubmed.ncbi.nlm.nih.gov/37714064/
HOPMANN, P.
et al.
Multiseptate gallbladder
presenting with biliary colic.
Journal of Surgical Case
Reports
, v. 9, p. 1-2, 2022. Disponível em:
gallbladder presenting with biliary colic - PubMed
HSIEH, Y.
et al.
Multisepstate gallbladder: A case report
and literature review.
Medicine
, v. 100, n. 49, p. 1-6,
2021.
Disponível
em:
https://pmc.ncbi.nlm.nih.gov/articles/PMC8663827/p
df/medi-100-e27992.pdf
ICHIKAWA, S.
et al
. Key Imaging Findings for the
Prospective Diagnosis of Rare Diseases of the
Gallbladder and Cystic Duct.
Korean Journal of
Radiology
, v. 22, n. 9, p. 1462-1474, 2021. Available in:
https://pubmed.ncbi.nlm.nih.gov/34132078/
OYACHI, N.
et al.
Multiseptate Gallbladder Coexisting
with Pancreaticobiliary Maljunction Treated by
Laparoscopic Cholecystectomy: report of a pediatric
case.
Surgical Case Reports
, v. 8, n. 16, p. 1-6, 2022.
Available
in:
https://pubmed.ncbi.nlm.nih.gov/35061125/
TERKAWI, R. S.
et al.
Understanding multiseptated
gallbladder: A systematic analysis with a case report.
JGH Open
, v. 5, n. 9, p. 988-996, 2021. Available in:
https://pmc.ncbi.nlm.nih.gov/articles/PMC8454487/
