Bibliographic record
Abstract
CASE REPORT A 33-year-old man presented with characteristic biliary colic. Laboratory tests, including liver function tests and inflammatory markers, were normal. An abdominal ultrasound revealed a well-circumscribed, anechoic pericholecystic fluid collection, without signs of acute cholecystitis (Figure 1). Subsequent magnetic resonance imaging/magnetic resonance cholangiopancreatography showed a duplicated gallbladder, each with a separate cystic duct entering the common bile duct (Figure 1).Figure 1.: (A) Ultrasound abdomen shows the native gallbladder (solid horizontal arrow) with a well-circumscribed small fluid collection (vertical arrow). (B) Magnetic resonance imaging/magnetic resonance cholangiopancreatography shows the duplicated gallbladder with a separate cystic duct (solid white arrow). (C) Duplicated gallbladder showed focal mucosal thickening by heterotopic gastric mucosa (1; original magnification 25×) with parietal cells (2; arrowheads; original magnification 200×). There was a background of chronic inflammation with foveolar (gastric pyloric) and focal squamous metaplasia (3; original magnification 100×).Gallbladder duplication (with distinct cystic ducts and arteries) was confirmed at the time of laparoscopic removal. There were no stones. The smaller “accessory” gallbladder showed mural thickening without mass-like lesion or nodularity grossly and histopathology revealed heterotopic gastric mucosa with parietal cells, a background of chronic inflammation with foveolar (gastric pyloric) and focal squamous metaplasia, and no neoplasia (Figure 1). Gallbladder duplication is a rare congenital anomaly, occurring in approximately 1 per 4,000 individuals.1 While often asymptomatic and discovered incidentally, it may present with biliary symptoms due to cholelithiasis or cholecystitis. Preoperative identification is crucial, as unrecognized duplication may increase the risk of biliary tree injury or incomplete cholecystectomy.2 Magnetic resonance imaging/magnetic resonance cholangiopancreatography showed is instrumental in these cases to delineate anomalous relationships between the gallbladder, cystic duct, and common bile duct. Gastric heterotopia within the gallbladder is exceedingly rare and is hypothesized to result from either a low-grade inflammatory response or aberrant embryological migration.3 Its clinical significance remains uncertain but underscores the importance of thorough histological evaluation. This case highlights the necessity for clinicians to consider rare anatomical variations in biliary pathology, as early recognition and surgical planning are essential in preventing complications. DISCLOSURES Author contributions: F. Jowhari: case review, compiling, editing, and writing final manuscript. D. Hurlbut: acquired/edited histological images of the case, editing of final manuscript. F. Jowhari is the article guarantor. Acknowledgments: Special thanks to Dr. Xi Wang for helping acquire and format the radiographic images from the case. Financial disclosure: None to report. Informed consent was obtained for this case report.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".