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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 4  |  Issue : 1  |  Page : 41-43

A case of left-sided gall bladder encountered during laparoscopic cholecystectomy


Department of Surgery, KPC Medical College and Hospital, Kolkata, West Bengal, India

Date of Web Publication5-May-2016

Correspondence Address:
Arijit Roy
KPC Medical College, 1F, Raja Subodh Chandra Mullick Road, Jadavpur, Kolkata - 700 032, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2320-3846.181815

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  Abstract 

Left-sided gall bladder (GB) without situs inversus is albeit recognized clinical entity. We report our experience of one case of left-sided GB in a 39-year-old male who underwent laparoscopic cholecystectomy for cholelithiasis. Left-sided GB may provide an unusual surprise to the surgeons during laparoscopy as routine preoperative studies may not always detect this anomaly. Awareness of the unpredictable confluence of the cystic duct to common bile duct and selective use of intraoperative cholangiography aids in the safe laparoscopic management of this unusual entity.

Keywords: Dextrocardia, sinistroposition, situs inversus totalis


How to cite this article:
Roy A, Jain V, Choudhury TK, Bhattacharya PK. A case of left-sided gall bladder encountered during laparoscopic cholecystectomy. Saudi Surg J 2016;4:41-3

How to cite this URL:
Roy A, Jain V, Choudhury TK, Bhattacharya PK. A case of left-sided gall bladder encountered during laparoscopic cholecystectomy. Saudi Surg J [serial online] 2016 [cited 2022 Aug 16];4:41-3. Available from: https://www.saudisurgj.org/text.asp?2016/4/1/41/181815


  Introduction Top


A left-sided gall bladder (GB) is a rare congenital anomaly defined as a GB attached to the lower surface of the left lateral segment of the liver, i.e., to the left of the interlobar fissure and round ligament.

This GB is situated under the left hemiliver between segments three and four or segment three to the left of the falciform ligament. Left-sided GB is a paraphysiologic phenomenon that when identified before surgery, must be properly evaluated with the use of computed tomography (CT)/magnetic resonance imaging. When incidentally discovered during surgery, it must be properly recognized by the surgeons who must be aware of the unpredictable confluence of the cystic duct to common bile duct (CBD).

If in doubt, the surgeons should perform an intraoperative cholangiography. We report one adult patient in whom left-sided GB was found incidentally intraoperatively and managed successfully.


  Case Report Top


A 39-year-old male patient presented to us with symptoms of chronic cholecystitis. His ultrasonography (USG) showed nothing abnormal except a GB packed with calculus [Figure 1]. Although not a routine practice in our institute, a magnetic resonance cholangiopancreatography (MRCP) was done for this patient from his referral institute [Figure 2]a and b. Even the MRCP was essentially normal except for cholelithiasis. As per the protocol, he was prepared for surgery and taken up for laparoscopic cholecystectomy. During surgery, the GB was seen lying on the left of the falciform ligament [Figure 3]. Careful dissection in the area of the Calot's triangle revealed a normal-looking cystic duct. The common hepatic artery was crossing the Calot's area in an abnormal manner; and on its way, a small twig emerged to supply the GB [Figure 4]. Once the anomalies were identified, the procedure was completed safely and the patient recovered without any complications.
Figure 1: Ultrasound imaging

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Figure 2: (a and b) Magnetic resonance cholangiopancreatography

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Figure 3: The gall bladder seen lying on the left of the falciform ligament

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Figure 4: Dissection in progress. Abnormally placed tented common bile duct. Clips applied on the short cystic duct

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  Discussion Top


A left-sided GB has a prevalence of 0.2% and may be associated with biliary and vascular anomalies. [1] Left-sided gallbladder can occur even without situs inversus totalis. Cholelithiasis is not more common in patients with situs inversus than the general population. However, these patients may pose a diagnostic difficulty. A report by Butt et al. states that an ultrasound scan can confirm the presence of gallstones and the left-sided gallbladder. [2] However, most studies state otherwise. Left-sided GB without situs inversus is a rare clinical entity and can provide an unusual surprise to the surgeons during laparoscopy. Awareness of unpredictable confluence of cystic duct into the CBD, selective use of intraoperative cholangiography, and modification of the technique aids in safe laparoscopic management of this unusual anomaly. [3]

Malposition of the GB occurring in the absence of situs inversus is a very rare anomaly. Two types of malpositions are known (1) medioposition (2) sinistroposition (true left-sided GB). [4] In medioposition, the GB is displaced medially to lie on the undersurface of the quadrate lobe (segment IV), but it is still on the right side of the round ligament. In sinistroposition, the GB lies under the left lobe (segment III) to the left of the round ligament. Hochstetter first described a case of sinistroposition in 1886 and since then, 105 cases have been reported till 1997. [5] Because routine preoperative examinations may not detect the anomaly, the latter may take surgeons by surprise during laparoscopy. [6] Despite repeated radiological investigations, diagnosis is usually made at the time of surgery. [7] In our case, preoperative USG and MRCP could not diagnose the abnormal disposition and this is consistent with most case reports. [5],[7],[8] However, left-sided gallbladder may be suspected on USG or CT scan when segment IV anatomy is not well defined. An initial impression of left-sided gallbladder is made when the ligamentum teres is deviated to the right side, and a right-sided umbilical portion of the portal vein is present. [5],[8],[9]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Alharthi S, Bernon M, Krige JE. Beware the left-sided gallbladder. S Afr J Surg 2012;50:88-9.  Back to cited text no. 1
    
2.
Butt MQ, Chatha SS, Ghumman AQ, Rasheed A, Farooq M, Ahmed J. Laparoscopic cholecystectomy for left sided gallbladder in situs inversus totalis. J Coll Physicians Surg Pak 2015;25:S22-3.  Back to cited text no. 2
    
3.
Chrungoo RK, Kachroo SL, Sharma AK, Khan AB, Nadim AS. Left-sided gall bladder: Report of two cases. J Minim Access Surg 2007;3:108-10.  Back to cited text no. 3
    
4.
Reddy PK, Subramanian RV, Yuvaraja S. Laparoscopic cholecystectomy for left-sided gallbladder (sinistroposition). JSLS 2005;9:356-7.  Back to cited text no. 4
    
5.
Nagai M, Kubota K, Kawasaki S, Takayama T, BandaiY, Makuuchi M. Are left-sided gallbladders really located on the left side? Ann Surg 1997;225:274-80.  Back to cited text no. 5
    
6.
Makni A, Magherbi H, Ksantini R, Rebai W, Safta ZB. Left-sided gallbladder: An incidental finding on laparoscopic cholecystectomy. Asian J Surg 2012;35:93-5.  Back to cited text no. 6
    
7.
Wong LS, Rusby J, Ismail T. Left-sided gall bladder: A diagnostic and surgical challenge. ANZ J Surg 2001;71:557-8.  Back to cited text no. 7
    
8.
Idu M, Jakimowicz J, Iuppa A, Cuschieri A. Hepatobiliary anatomy in patients with transposition of the gallbladder: Implications for safe laparoscopic cholecystectomy. Br J Surg 1996;83:1442-3.  Back to cited text no. 8
    
9.
Asonuma K, Shapiro AM, Inomata Y, Uryuhara K, Uemoto S, Tanaka K. Living related liver transplantation from donors with the left-sided gallbladder/portal vein anomaly. Transplantation 1999;68:1610-2.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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