Multiseptated gallbladder (MSG) is a rare condition with less than 50 reported cases, with only 13 in pediatrics. Pathogenesis is likely secondary to incomplete cavitation of the embryonic gallbladder (1,2). Other theories postulate the gallbladder develops faster than its surrounding structures, causing wrinkling because of lack of space, thus dividing into multiple compartments creating a honeycomb or grape-like cluster appearance (3-6).MSG is associated with other anomalies in cluding gallbladder ectopy, choledochal cysts, and anomalous biliopancreatic junction, with possible increased risk of developing cholangiocarcinoma (5,7,8).A 16-year-old boy presented with a 1-year history of right upper quadrant pain, nausea, and vomiting. Evaluation revealed normal labs and an upper endoscopy. An abdominal sonogram showed small anechoic structures within the gallbladder, likely secondary to adenomyomatosis.Symptoms persisted despite treatment with a proton pump inhibitor, and the patient was reevaluated at our center. Repeat endoscopy and hepatobiliary scan were normal. Repeat sonogram revealed MSG (Fig. 1), and the patient underwent a cholecystectomy. Gallbladder revealed multiple cystic cavities ranging from 0.3 to 0.8 cm, filled with mucin-like material and chronic focal inflammation, without evidence of dysplasia (Figs. 2 and 3).Patient remains asymptomatic 4 months post cholecystectomy.MSG is considered a benign condition, but with a possible increased risk of developing cholangiocarcinoma (6). Therefore, cholecystectomy should be considered, especially in symptomatic patients.

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