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

Abstract

A left-sided gallbladder without a right-sided round ligament, which is called a true left-sided gallbladder, is extremely rare. A 71-year-old woman was referred to our hospital due to a gallbladder polyp. Computed tomography (CT) revealed not only a gallbladder polyp but also the gallbladder located to the left of the round ligament connected to the left umbilical portion. CT portography revealed that the main portal vein diverged into the right posterior portal vein and the common trunk of the left portal vein and right anterior portal vein. CT cholangiography revealed that the infraportal bile duct of segment 2 joined the common bile duct. Laparoscopic cholecystectomy was performed for a gallbladder polyp, and the intraoperative finding showed that the cholecystic veins joined the round ligament. A true left-sided gallbladder is closely associated with several anomalies; therefore, surgeons encountering a true left-sided gallbladder should be aware of the potential for these anomalies.

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

“…In such a case, the cystic duct joins the extrahepatic duct or left hepatic duct from the left side. [7]…”

“…[11] There are recent cases where neither the common pre-operative ultrasonography detect the LSG [6], [12], [13] nor the abdominal CT. [5] On the other hand, there are recent cases in which CT revealed LSG[7], [9] an if so, further study such as angiography, CT- angiography or MRI are suggested for a well-organized laparoscopic cholecystectomy [14].…”

“…[13] Such anomalies are: complete or partial situs inversus, duplicated gallbladder [16] various portal venous [17] and biliary anomalies [8] , cholecystic venous anomaly [7] and atrophy of segment IV of the liver. [12] In addition, the cystic artery always crosses in front of the common bile duct from right to left.…”

“…[13] When LSG exists, the cystic duct may join the left or right side of the common hepatic duct or may join the left hepatic duct directly. [9] Moreover there are recent case reports, referring to hypoplastic bile duct, [16] duplication of the common bile duct, [15] infraportal bile duct [7] and abnormal pancreatico-biliary duct junction. [8] Occurring to these, an intra-operative cholangiography might be used as a guide to the dissection [15] since delineating biliary anatomy.…”

True left‐sided gallbladder: a rare anatomical anomaly and its associated surgical challenges

“…Similarly, preoperative imaging often fails to diagnose LSG as seen in our case. However, there have been reported cases of preoperative identification of a LSG . In these cases, further imaging with magnetic resonance imaging or computed tomography cholangiography is possible to further delineate the anatomy …”