Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 56 11 2019 01 16 729 731 EN Vitorino Modesto dos Santos Department of Internal Medicine, Armed Forces Hospital and Catholic University of Brasília, Brasília-DF, Brazil Samuel Abner Department of Internal Medicine of Armed Forces Hospital, Brasília-DF, Brazil. Marcelo Oliveira Gastroenterology Division of Armed Forces Hospital, Brasília-DF, Brazil. Viviane Soares Department of Internal Medicine of Armed Forces Hospital, Brasília-DF, Brazil. Uadson Barreto Department of Internal Medicine of Armed Forces Hospital, Brasília-DF, Brazil. Lister Santos Department of General Surgery, State Workers Hospital, São Paulo-SP, Brazil. 2017 04 24 2017 04 30 A 65-year-old woman with hypothyroidism and arterial hypertension was admitted with epigastric pain and hyperemesis. Five months before, she had the diagnosis of non-lithiasic acute pancreatitis without complications, and the hypothesized etiology was alcohol abuse. The current manifestations were initially related to an active gastric ulcer evidenced by the endoscopic study. Laboratory data were consistent with acute pancreatitis, and ultrasonography showed images of pancreatitis, in addition to the incidental detection of the hydropic gallbladder with a Phrygian cap. These diagnoses were confirmed by the imaging study of computed tomography with contrast. Clinical significance of Phrygian cap anomaly is herein emphasized because of diagnostic challenges, in addition to possible etiopathogenic role in cholecystitis, gallstones, and pancreatitis. The eventual association of the gallbladder anomaly with the Saint’s triad is also commented. This scarcely reported triad includes hiatus hernia, diverticulosis, and lithiasic cholecystopathy.   https://acta.tums.ac.ir/index.php/acta/article/view/6398 https://acta.tums.ac.ir/index.php/acta/article/download/6398/5186