Implications of Left-sided Gallbladder in the Emergency Setting: Retrospective Review and Top Tips for Safe Laparoscopic Cholecystectomy

Abstract

Increased awareness of the anatomic aberrations in LSG-woSVI associated with improved preoperative diagnosis and a good knowledge about safe surgical techniques for cholecystectomy could indubitably reduce the incidence of BDI.

True left-sided gallbladder: A case report and comparison with the literature for the different techniques of laparoscopic cholecystectomy for such anomalies

“…True LSG is a rare and unusual, albeit a well-recognized, anomaly; it may present with right-sided symptoms and exhibit a clinical picture similar to that associated with a normally positioned gallbladder. This makes its preoperative diagnosis a clinical challenge [ 2 ]. Abongwa et al [ 2 ] reviewed 55 patients with LSG-woSVI, of which 83% of patients had T-LSG; a vast majority (75%) of these patients presented with RUQ pain.…”

“…Left-sided gallbladder (LSG) is a rare anomaly; the reported incidence ranges from 0.2% to 1.1 [ 1 ]. Normally, the gallbladder resides in the gallbladder fossa between hepatic segments IV and V. LSG is defined as a gallbladder located on the left side of the round ligament or ligamentum teres [ 2 ]. There are three recognized variants of LSG: LSG associated with situs viscerum inversus (SVI), true LSG (T-LSG), and gallbladder located to the left of abnormally located right-sided round ligament/ligamentum teres (R-LSG) [ 3 ].…”

“…There are three recognized variants of LSG: LSG associated with situs viscerum inversus (SVI), true LSG (T-LSG), and gallbladder located to the left of abnormally located right-sided round ligament/ligamentum teres (R-LSG) [ 3 ]. LSG without SVI (LSG-woSVI), which comprises T-LSG and R-LSG, is a rare anomaly and is typically discovered incidentally during surgery [ 2 ]. T-LSG should be differentiated from R-LSG; it is positioned to the left of the ligamentum teres and falciform ligament and is located under the surface of the left liver lobe segment III [ [3] , [4] , [5] ].…”

“…T-LSG is the most common type of LSG-woSVI [ 2 ]. There are several theories pertaining to the embryological origin of T-LSG.…”

Delayed diagnosis of abdominal pain in patient with situs inversus totalis in emergency department

“…For the patients with left upper abdominal pain, cholelithiasis associated with SIT should be considered besides acute myocardial infarction, peptic ulcer, [ 4 ] ulcer perforation, [ 5 ] acute cholecystitis, [ 6 ] cholelithiasis, [ 7 ] acute pancreatitis, [ 6 ] and left-sided gallbladder without SVI. [ 13 ] However, the emergency physician on duty are prone to ignore situs inversus without careful physical examination and any imaging studies such as ultrasonography, x-ray, and abdominal CT scan. With high suspicion and adequate observation, doctors may find the abnormal features.…”