Laparoscopic cholecystectomy for a left-sided gallbladder

Abstract

Cholecystectomy is a common procedure. Abnormalities in the anatomy of the biliary system are common but an abnormal location of the gallbladder is much rarer. Despite frequent pre-operative imaging, the aberrant location of the gallbladder is commonly discovered at surgery. This article presents a case of a patient with the gallbladder located to the left of the falciform ligament in the absence of situs inversus totalis that presented with right upper quadrant pain. A laparoscopic cholecystectomy was performed and it was noted that the cystic duct originated from the right side. The presence of a left sided gall bladder is often associated with various biliary, portal venous and other anomalies that might lead to intra-operative injuries. The spectrum of unusual positions and anatomical gallbladder abnormalities is reviewed in order to facilitate elective and emergent cholecystectomy as well as other hepatobiliary procedures. With proper identification of the anatomy, minimally invasive approaches are still considered safe.

Keywords: Left sided gallbladder, Laparoscopic cholecystectomy, Sinistroposition of the gallbladder, Situs inversus, Bile duct anomaly, Liver anomalies, Portal vein anomaly, Liver transplant

Core tip: In the absence of situs inversus, left sided gallbladders are rare anomalies. They are most commonly encountered during surgery as they usually present with right sided pain and routine preoperative testing fails to identify them. Various biliary, portal venous and other anomalies are associated with left sided gallbladders and their spectrum is reviewed in this article. Recognition of these associated anomalies will help achieve safety in hepatobiliary procedures and prevent injuries.