Urgent cholecystectomy in patient with left-sided gallbladder

Abstract

INTRODUCTION: Sinistroposition of the gallbladder, or true left-sided gallbladder (LSG) without situs viscerum inversus,
is a rare congenital anatomical variant where the gallbladder is located to the left of round/falciform ligament. It can
be associated with anomalies of the biliary tree, portal system and hepatic vascularization. The surgical management of
a LSG could be challenging even for an experienced operator, being usually an incidental intraoperative finding.
CASE REPORT: A 72 years old woman was admitted to our emergency department because of acute cholecystitis. There
were no pre-operative indications of sinistroposition of the gallbladder and its aberrant position was discovered during
the explorative laparoscopy; because of the unusual anatomy and chronic flogosis, the laparoscopic approach was converted to open surgery. The patient underwent a successful intervention and was discharged after 4 days without complications. Her family history revealed a daughter with biliary atresia.

DISCUSSION: LSG could remain undetected at preoperative imaging, but today, with advances in diagnostic imaging,
the report of this condition has increased. Several hypothesis suggest the presence of an underlying embriologic mechanism for LSG and its associated anomalies, but its etiology is still unknown. The association with the daughter’s biliary
atresia makes reasonable a possible genetic correlation with this condition.

CONCLUSIONS: In case of LSG, laparoscopic cholecystectomy could be feasible and safe, but with an increased risk of
injury to the major biliary structures, mostly in case of severe and chronic inflammation of the gallbladder. Surgeons
have to know this variant because of its associated hepatic anomalies.