True left-sided gallbladder with variations of bile duct and cholecystic vein

Successful Surgical Management of Unusual Gallbladder Anatomy Through Laparoscopic Cholecystectomy of Ectopic Gallbladder

Abnormalities in the position of the gallbladder are not encountered commonly such as the ectopic location. We present a case of laparoscopic cholecystectomy for gallbladder that was found in an ectopic position. The surgical procedure can be difficult in some cases of acute cholecystitis and ectopic position of the gallbladder may add to complexities of the procedure due to abnormal location or anatomical variants of the biliary tree. Preoperative identification of ectopic gallbladder may aid in planning and performing a safe surgical procedure.

Look, but to the left: A rare case of gallbladder sinistroposition and comprehensive literature review

Left-sided gallbladder (LSGB) is a rare anatomic variation that, while benign in the context of its transposition, is of significant intraoperative importance. Due to its association with other anatomic anomalies involving key structures in the hepatobiliary system, discovering it intraoperatively as opposed to preoperatively suddenly increases the difficulty of a gallbladder procedure.

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Left-sided gallbladder (LSGB) is a rare anatomic variation that, while benign in the context of its transposition, is of significant intraoperative importance.

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Although laparoscopic cholecystectomy of a LSGB is safe, it is associated with higher risk of complications such as common bile duct injury.

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Most cases of a LSGB are diagnosed intraoperatively, and this sudden discovery during the procedure can increase the difficulty, duration, and stress of the procedure due to the other potential anatomic anomalies that LSGB is associated with in the hepatobiliary system.

The diagnostic value of high-frequency ultrasound combined with color Doppler ultrasound versus surgical pathology in gallbladder polyps

OBJECTIVE

This study aimed to analyze the value of high-frequency ultrasound combined with color Doppler ultrasound in the diagnosis of gallbladder polyps.

METHODS

A retrospective analysis was performed on 108 patients with gallbladder polyps, all of whom were examined by high-frequency ultrasound and color Doppler ultrasound with surgical or pathological findings as the gold standard.

RESULTS

Taking surgical pathology findings as the gold standard, the diagnostic accuracy, sensitivity and specificity of high-frequency ultrasound for gallbladder polyps were 63.89%, 63.27%, and 70.00%, respectively. The diagnostic accuracy, sensitivity and specificity of color Doppler ultrasound were 74.07%, 73.47%, and 80.00%, respectively. The diagnostic accuracy, sensitivity and specificity of high-frequency ultrasound combined with color Doppler ultrasound were 91.67%, 90.82%, and 100.00%, respectively. The proportion of mulberry-like or papillary projections was 56.18% in 89 benign lesions diagnosed by high-frequency ultrasound combined with color Doppler ultrasound, the proportion of hyperechoic lesion was 47.19%, and the proportion of single lesion was 59.55%. The incidence rate of blood flow signal was 26.97% in 89 benign lesions, including 10 cases of punctiform blood flow signal, 9 cases of band-like blood flow signal and 5 cases of multiple stones in the lumen of the gallbladder.

CONCLUSION

High-frequency ultrasound combined with color Doppler ultrasound has high accuracy in the diagnosis of gallbladder polyps, and can yield better diagnostic results than either method, which can be used as an optional method for the diagnosis of gallbladder polyps.

Left sided gallbladder: A case report during laparoscopic cholecystectomy for acute cholecystitis

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Left-sided gallbladder.

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Acute Choleystitis.

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Laparoscopic Cholecystectomy.

Introduction

A true left sided gallbladder (T-LSG) is a rare finding mostly discovered incidentally during laparoscopy and often associated with several anatomic anomalies; surgical approach may be challenging with an increased risk of intra-operative injuries and conversion to open.

Presentation of the case

A 76 years old woman presented with acute cholecystitis. The left sided gallbladder was unexpectedly discovered as an intra-operative finding. Laparoscopic cholecystectomy was carried out using our usual trocar set-up without the need of intra-operative cholangiography or conversion to open.

Discussion

LSG is reported to be associated with a higher risk of intraoperative bile duct injuries (up to 7.3%) due to anomalies of the bile duct, portal vein, and other structures. Achieving the Critical View of Safety by opening Calot’s triangle is essential to avoid bile duct injuries.

Conclusion

Experienced surgeons could safely approach LSG laparoscopically, also in emergency setting, without major changing in their surgical technique with limitation of diathermy use and prudent dissection of anatomical structures to avoid biliary injuries. Intra-operative cholangiography is not mandatory.

A Rare Case of a Left-sided Gallbladder Accompanied with an Aplastic Cystic Duct in a Patient with Acute Cholecystitis

BACKGROUND A left-sided gallbladder without situs inversus is a rare congenital anomaly of the gallbladder with a prevalence ranging from 0.04-0.3%. CASE REPORT We present a case of a female patient, referred to our clinic with clinical features of an acute cholecystitis. After performing the standard preoperative investigations, which confirmed the diagnosis, the patient underwent a laparoscopic cholecystectomy. We found a left-sided gallbladder, attached to the lower surface of the left lobe of the liver. During the dissection in the Callot triangle an aplastic cystic duct was also identified. The extirpation of the gallbladder was performed anterograde, allowing a better exposition of the critical structures. CONCLUSIONS A left sided gallbladder is almost an incidental finding, which can be accompanied with further anomalies of the biliary tree. A combination of these 2 variations is very rare without any other reported cases in the literature.

Left side gallbladder with agenesis of right anterior sector and absence of right hepatic duct. A case report

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Left side gallbladder is more often discovered intraoperatively.

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A lot of anatomical variations are described.

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The three-dimensional reconstruction can better highlight intra and extraparenchimal anatomy.

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The knowledge of this anomaly could be useful both in cholecystectomy technique and liver resection.

Introduction

Left sided gallbladder is a rare congenital abnormality more often discovered as incidental finding during laparoscopic cholecystectomy requiring surgical challenge to prevent complication. We present a case of a true left sided gallbladder treated with laparoscopic cholecystectomy.

Case

A 90 y/o woman with acute abdominal pain was hospitalised and underwent a laparoscopic cholecystectomy. A preoperative CT scan didn't show the variation. Intraoperative finding revealed a true left sided gallbladder that was carefully dissected at the Calot's triangle with identification of the cystic duct and artery. After a complete separation of the gallbladder from the liver, the cystic duct and the artery were safely clipped and transected. CT scan reconstruction reveal agenesis of the right superior sector with simultaneous absence of the right biliary duct.

Discussion

True left sided gallbladder is defined as one attached in the left of the ligamentum teres and falciform ligament. This abnormality predispose to a numerous anatomical variation. Unfortunately its finding is more often incidentally during intervention and recognition of such variation could be difficult that can be of high risk for surgical injury.

Conclusion

Left sided gallbladder presents a significant challenge to the surgeon and makes it even more difficult to avoid postoperative complications. Therefore, a careful dissection of Calot’s triangle and the complete mobilisation of the gallbladder should be done before clipping the cystic duct and artery. However, if a preoperative finding suggests a left sided gallbladder, then an in-depth preoperative anatomical study is advocated.

1st report of unexpected true left-sided gallbladder treated with robotic approach

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For left-sided gallbladder, no change of port setting is needed using the robot.

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ICG helps to recognize associated vascular and biliary anomalies.

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Anatomical variations assessment is crucial to avoid biliary or vascular injuries.

Introduction

True left-sided gallbladder (T-LSG) occur when the gallbladder is positioned to the left of the ligamentum teres and falciform ligament and under the surface of the left liver lobe.

Presentation of case

Patient is 29-year-old caucasian male, presenting with 9-month history of epigastric right upper quadrant (RUQ) colic pain. RUQ Ultrasound reported cholelithiasis, gallbladder wall thickening, and no intrahepatic biliary dilation.

Discussion

Robotic cholecystectomy was the chosen approach. When visceral surface of the liver was exposed, anomalous location of the gallbladder was noted, left to the round ligament. A cystic duct with a “hairpin” configuration and a very cephalad cystic artery were identified. Cholecystectomy was performed safely and uneventfully.

Conclusion

No change of port setting was required with the robotic approach. The ICG-aided cholangiography improved surgeon’s ability to recognize the concomitant vascular and biliary anomalies. However, no definitive conclusion can be drown until further experience and volume are achieved.

Laparoscopic cholecystectomy for acute cholecystitis in a patient with left-sided gallbladder: a case report

BACKGROUND

Left-sided gallbladder is a relatively rare anatomical variation that is frequently associated with a biliary system anomaly. Here, we describe a case of left-sided gallbladder with acute cholecystitis treated by laparoscopic cholecystectomy.

CASE PRESENTATION

An 86-year-old man with acute upper abdominal pain was admitted to our hospital. Computed tomography demonstrated that the gallbladder was centrally dislocated and the wall enhancement was discontinued. Magnetic resonance cholangiopancreatography showed that the gallbladder wall was thickened and abnormally swollen. A laparoscopic cholecystectomy was performed. The round ligament was attached to the right side of the gallbladder, and the left-sided gallbladder was diagnosed by intraoperative findings. The patient was discharged 5 days after surgery without postoperative complications.

CONCLUSIONS

A flexible and optimal port site should be inserted in cases of left-sided gallbladder with acute cholecystitis. An assessment of the extra- and intrahepatic biliary system is essential to avoid biliary injury in cases of left-sided gallbladder with acute cholecystitis.

Embryology, Anatomy, and Imaging of the Biliary Tree

"The anatomy of the biliary tree is notoriously variable. This variation is the bane of the hepatobiliary surgeon, to whom an understanding of biliary anatomic variation is key to the planning and safe conduct of liver surgery, from oncological resections to split-liver transplantation. The hepatic diverticulum, also termed "the liver bud," is the first semblance of the biliary system in the human embryo. A variety of techniques used in the mid twentieth century for imaging the biliary tree have since been abandoned in favor of more practical, safer, less invasive, and more sensitive and specific contemporary methods."

Double pouched, sigmoid gallbladder that can cause a diagnostic dilemma to radiologists: a case report

Gallbladder shows frequent variations in position, shape, interior, and its duct system. These variations may go unnoticed lifelong; however, they may predispose it for cholecystitis and cholelithiasis. We observed a double pouched gallbladder in an adult male cadaver. The gallbladder was folded to have a sigmoid shape. It had two broad pouches: anterior and posterior and a narrow isthmus in between. Its anterior pouch was covered by peritoneum, whereas the posterior pouch was covered by extrahepatic connective tissue. We discuss the clinical and radiological importance of the case.

Sinistroposition: A case report of true left-sided gallbladder in a Vietnamese patient

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Left-sided gallbladder without situs viscerum inversus is a rare congenital anomaly.

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Left-sided gallbladder is accompanied by anatomic variations: portal vein and/or biliary system anomalies, segment IV atrophy, variations in hepato-biliary vascular anatomy.

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Left-sided gallbladder can present significant intraoperative challenges due to associated variations in ductal and vessel anatomy.

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There are three proposed, embryologic mechanisms for Left-sided gallbladder without situs viscerum inversus.

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Even the face of routine preoperative testing, ultrasound, and CT scan, left-sided gallbladder often remains undetected until surgery.

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Laparoscopic antegrade cholecystectomy can be performed safely for left-sided gallbladder.

Introduction

Left-sided gallbladder without situs viscerum inversus (LSG-woSVI) is defined as a gallbladder located under the left lobe of the liver; to the left of the round/falciform ligament, but with all other viscera maintaining normal anatomical relationships. This is a rare congenital anomaly with a reported prevalence that ranges from 0.04% to 1.1%. It is usually an incidental intraoperative finding, and can be associated with anatomic abnormalities of the biliary tree, portal system and vasculature. LSG and associated variations may present significant challenges even for experienced surgeon.

Presentation of case

LSG-woSVI was unexpectedly discovered in a 49-year-old, Vietnamese female during laparoscopic cholecystectomy. There were no pre-operative indications of sinistroposition. The cystic duct joined the common hepatic duct on the right side, and the cystic artery crossed anterior to the common bile duct in a right-to-left direction. Antegrade cholecystectomy was performed without intraoperative or postoperative complications.

Discussion

LSG is a rare anatomical variation that often remains undetected with ultrasound and pre-operative tests. Several hypotheses suggest underlying embryologic mechanisms for LSG and associated anomalies in ductal, portal and vascular anatomy, but the exact cause remains a mystery. Safe laparoscopic cholecystectomy can be done; however, there is an increased risk of injury to the major biliary structures compared to orthotopic gallbladder.

Conclusion

Laparoscopic antegrade cholecystectomy is feasible for LSG. However, surgeons need to be cognizant of anatomy, so that rapid modifications of surgical technique can ensure positive patient outcomes.

Gallbladder to the left side of the falciform ligament in absence of Situs Inversus "Sinistroposition" - Case series of 2 patients with this anomaly who underwent mini-laparoscopic cholecystectomy

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Left-sided Gallbladders are considered a rare anatomic anomaly, even though, prevalence is increasing.

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This can be an incidental finding during surgery.

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It is in part due to the fact that radiographic images tipically do not detect them.

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Due to this, surgeons must be aware of this anomaly during surgery.

Introduction

Gallbladders located to the left of falciform ligament, without situs inversus, are denominated sinistroposition or true left-sided gallbladders; it is considered a rare anatomic anomaly with a prevalence in between 0.1% and 0.7%. Left-sided gallbladder usually occur as a component of situs inversus.

Presentation of cases

We report a case series of two patients of true left-sided gallbladder that were found at our institution from 2015 to 2017; the anatomic anomalies were discovered during the performance of mini-laparoscopic cholecystectomy due to acute cholecystitis with cholelithiasis in both cases. Both patients underwent a successful surgery and there were no postsurgical complications.

Discussion

The reported prevalence of left-sided gallbladder is between 0.1% and 0.7%, thus considered a rare anatomic finding. Currently, with advances in diagnostic imaging modalities, the report of left-sided gallbladder has increased nowadays. It may be a more common anomaly than previously thought.

Conclusion

True left-sided gallbladder can be an incidental finding; it is in part due to the fact that radiographic images do not typically detect this anomaly, therefore surgeons must be aware of this condition because it is associated with anomalies in the intrahepatic portal vein and biliary tree.

A case report on a left sided gallbladder: A rare finding during cholecystectomy

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Cholecystectomy is a common procedure increasingly performed in the day surgery setting.

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A true left sided gallbladder is a rare finding. Retrospective studies suggest a prevalence of 0.1–0.7%.

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Exact aetiology and pathway for its anatomical variation is has yet to be determined.

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It can be associated with number of other structural variation affect the biliary system the knowledge of which is paramount in hepatobiliary surgery.

Introduction

Cholecystectomy is the surgical removal of gallbladder for symptomatic gallstones disease or where exist the risk of gallbladder malignancy. Its performed routinely across the globe often as day surgery. In this case report, we describe an incidental intra operative finding of a left sided gallbladder creating a technical challenge for the surgeon.

Case

We describe the case of 35 year old female who presented with RUQ pain. Ultrasound examination revealed gallstones. Intraoperative findings during routine cholecystectomy were of a left sided gallbladder. The surgical procedure in performing laparoscopic surgery required an extra port placement for safe and effective dissection.

Discussion

The finding of left sided gallbladder is a rare congenital anomaly and has a prevalence of 0.1–0.7%. A true left sided gallbladder is one that is found to the left of the ligamentum teres and falciform ligament and the cystic artery always crosses in front of the CBD from right to left. There are various abnormalities associated this anatomical variant from abnormality of the biliary tree to the porto-venous anatomy. Failure to recognise these variations can lead to serious complications especially in hepatobiliary surgery.

Conclusion

The finding of left sided gallbladder is an abnormality which is often discovered intraoperatively. It may provide the surgeon with operative challenges in performing the surgery safely and increase the incidence of morbidity. If there is any clinical suspicion of the presence of a left sided gallbladder, pre-operative CT angiography and/or intraoperative cholangiography should be performed to minimise the risk of intraoperative complications.

Preoperative evaluation of accessory hepatic ducts by drip infusion cholangiography with CT

BACKGROUND

This retrospective study aimed to investigate the incidence of each type of accessory hepatic duct by drip infusion cholangiography with CT (DIC-CT).

METHODS

Five hundred sixty nine patients who underwent preoperative DIC-CT and laparoscopic cholecystectomy were reviewed. Accessory hepatic ducts were classified as follows: type I (accessory hepatic ducts that merged with the common hepatic duct between the confluence of the right and left hepatic ducts and the cystic duct confluence), type II (those that merged with the common hepatic duct at the same site as the cystic duct), type III (those that merged with the common bile duct distal to the cystic duct confluence), type IV (the cystic duct merged with the accessory hepatic duct), and type V (accessory hepatic ducts that merged with the common hepatic or bile duct on the left side).

RESULTS

Accessory hepatic ducts were observed in 50 patients. Type I, II, III, IV, and V accessory hepatic ducts were detected in 32, 3, 1, 11, and 3 patients, respectively. Based on their drainage areas, the accessory hepatic ducts were also classified as follows: a posterior branch in 22 patients, an anterior branch in 9 patients, a combination of posterior and anterior branches in 16 patients, a left-sided branch in 2 patients, and a caudate branch in 1 patient. None of the patients with accessory hepatic ducts suffered bile duct injuries.

CONCLUSION

There are a number of variants of the accessory hepatic duct. DIC-CT is useful to detect the accessory hepatic duct.

Left-sided gallbladder (Sinistroposition) encountered during laparoscopic cholecystectomy: A rare case report and review of the literature

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LSG is a peculiar anatomical variation that is difficult to be identified preoperatively.

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LSG is associated with anatomical anomalies that may lead to intra-operative injuries.

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Safe laparoscopic cholecystectomy is feasible by placing the patient to left-side up position for better exposure of the operative field.

Introduction

True Left-sided gallbladder (LSG) is a rare anatomical variation with a prevalence of 0.3%. Mainly discovered during the operation, its surgical approach in the laparoscopic setting may be challenging even for an experienced surgeon.

Presentation of case

LSG was unexpectedly discovered in a young man during laparoscopic cholecystectomy. There were no pre-operative indications of this sinistroposition. The laparoscopic cholecystectomy was performed with minor surgical modifications and it was uneventful. A meticulous review of recent literature about LSGs was conducted as well.

Discussion

LSG is a scarce anatomical aberration that is difficultly identified pre-operatively. Surgeons should be aware of this aberration and of its accompanying anatomical variations in order to perform a safe laparoscopic cholecystectomy.

Conclusion

Surgeons, by placing the patient to left-side up position, are able to expose the Calot’s triangle and possible accompanying anatomical anomalies and thus perform a safe laparoscopic cholecystectomy without difficult surgical modifications.