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

Almas, Talal; Murad, Muhammad Faisal; Mansour, Eyad; Khan, Muhammad Kashif; Ullah, Mujib; Nadeem, Faisal; Shafi, Adil; Khedro, Tarek; Almuhaileej, Mohammad; Abdulhadi, Abdulaziz; Alshamlan, Abdulaziz; Nagarajan, Vikneswaran Raj; Mansoor, Emad

doi:10.1016/j.amsu.2021.103016

Cited by 3 publications

(6 citation statements)

References 16 publications

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“…Gallbladder is situated on the undersurface of segment IV and V of liver and has a peritoneal attachment to liver. 5 The critical knowledge of anatomy, its variations and clinical experience is necessary for a safe and uneventful surgery. 3 The gallbladder is a pear shaped organ with an average length of 4.5 to11.6 cm and capacity of 30 to 50ml.…”

Section: Discussionmentioning

confidence: 99%

Large gallbladder Removed by Laparoscopic Cholecystectomy A Case report

Ullah

Murad

War

2023

J Islamabad Med Dental Coll

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Gallbladder stones impacted at neck of gallbladder can result in acute calculous cholecystitis with mucocele gallbladder. Laparoscopic cholecystectomy is performed in such cases as an emergency surgery. We present a case long gallbladder with mucocele formation that was managed by laparoscopic approach. The gallbladder removed was 27.8cm in length. This is the longest gallbladder removed by laparoscopic cholecystectomy in Pakistan so far. The patient had uneventful recovery.

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Section: Discussionmentioning

confidence: 99%

Large gallbladder Removed by Laparoscopic Cholecystectomy A Case report

Ullah

Murad

War

2023

J Islamabad Med Dental Coll

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“…Existing literature suggests an incidence of approximately .04%-1.1%; however, the true incidence is unknown and may be higher than previously reported. 1,2 The etiology of left-sided gallbladder positioning is unknown and likely embryological in nature. Aberrant positioning of the gallbladder may be accompanied by distorted vascular and biliary anatomy which can complicate the traditional surgical approach and increase risk of damage to vital structures.…”

mentioning

confidence: 99%

“…Given their low incidence, left-sided gallbladders are presumably a variant that relatively few surgeons will encounter clinically; however, the intraoperative consequences make them worthy of review. 2 The presence of a left-sided gallbladder in the absence of situs inversus may be classified as either sinistroposition or medioposition. Sinistroposition describes a true left-sided gallbladder that forms to the left of the falciform ligament secondary to leftward migration of the embryologic cystic bud.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

“…Sinistroposition describes a true left-sided gallbladder that forms to the left of the falciform ligament secondary to leftward migration of the embryologic cystic bud. 2 Conversely, medioposition describes a gallbladder that is correctly situated on the right lobe of the liver but appears left-sided due to a rightward deviation of the falciform ligament. 4 True left-sided gallbladders (as in our case) are associated with higher degrees of vascular and hepatobiliary anomalies and therefore a higher risk of intraoperative injury to vital structures.…”

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confidence: 99%

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Challenges, Preoperative Assessment, and Surgical Strategies for the Left-Sided Gallbladder

Starich,

Chanes,

Bakhtiyar

et al. 2024

The American Surgeon™

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Left-sided gallbladder positioning, or sinistroposition, is a rare anatomical variation that poses challenges during surgical intervention due to associated vascular and biliary anomalies. While existing literature suggests an incidence of approximately 0.04-1.1%, it remains an underreported phenomenon that falls well outside the realm of “expected” anatomical variation and are rarely identified on preoperative imaging. Here, we present a case of acute cholecystitis in a patient with unexpected left-sided gallbladder, highlighting the associated challenges and outlining both preoperative and intraoperative strategies for managing this rare but consequential anatomical variant. In this case, a 49-year-old woman with a prior history of bilateral ovarian cysts presented with clinical, laboratory, and imaging findings consistent with acute cholecystitis. She underwent laparoscopic cholecystectomy and was found to have a severely inflamed left-sided gallbladder that was obscured by omentum. Her gallbladder was found in the midline immediately beneath the falciform ligament, with most of the gallbladder body and fundus attached to liver segment III, situated to the left of the midline. An additional left-sided mid-abdominal port was required to enhance retraction, and an intraoperative cholangiogram (IOC) was performed given the elevated risk of structural injury. This case underscores the heightened intraoperative risk associated with deviations in vascular and biliary anatomy and provides recommendations for intraoperative adaptations to mitigate these risks.

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Clinical significance of Left-Sided Gallbladder for laparoscopic cholecystectomy and hepatectomy

et al. 2023

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A left-sided gallbladder (LSG) represents a rare anatomical variation defined by the location of the gallbladder to the left side of the liver falciform and round ligaments, which is often not discovered until surgery. The reported prevalence of this ectopia ranges from 0.2% to 1.1%, however, those values may be underestimated. It is mostly an asymptomatic condition, thus not causing the patient any harm, and being few reported cases in the current literature. Based on clinical presentation and standard diagnostic procedures, LSG can remain undetected and represent accidental intraoperative finding. The attempts to explain the cause of this anomaly have been different, but the numerous variations described do not allow a clear definition of its origin. Although this debate is still open, it is of considerable importance to know that LSG is frequently associated with alterations of both the portal branches and the intrahepatic biliary tree. The association of these anomalies, therefore, represents an important risk of complications in cases when surgical treatment is necessary. In this context, our literature review aimed to summarize possible anatomical anomalies coexisting with LSG and discuss the clinical significance of the LSG, when the patient requires cholecystectomy or hepatectomy.

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

Cited by 3 publications

References 16 publications

Large gallbladder Removed by Laparoscopic Cholecystectomy A Case report

Large gallbladder Removed by Laparoscopic Cholecystectomy A Case report

Challenges, Preoperative Assessment, and Surgical Strategies for the Left-Sided Gallbladder

Clinical significance of Left-Sided Gallbladder for laparoscopic cholecystectomy and hepatectomy

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