Abstract
BackgroundLeft-sided gallbladder is a relatively rare anatomical variation that is frequently associated with a biliary system anomaly. Here, we describe a case of left-sided gallbladder with acute cholecystitis treated by laparoscopic cholecystectomy.Case presentationAn 86-year-old man with acute upper abdominal pain was admitted to our hospital. Computed tomography demonstrated that the gallbladder was centrally dislocated and the wall enhancement was discontinued. Magnetic resonance cholangiopancreatography showed that the gallbladder wall was thickened and abnormally swollen. A laparoscopic cholecystectomy was performed. The round ligament was attached to the right side of the gallbladder, and the left-sided gallbladder was diagnosed by intraoperative findings. The patient was discharged 5 days after surgery without postoperative complications.ConclusionsA flexible and optimal port site should be inserted in cases of left-sided gallbladder with acute cholecystitis. An assessment of the extra- and intrahepatic biliary system is essential to avoid biliary injury in cases of left-sided gallbladder with acute cholecystitis.
Highlights
Left-sided gallbladder is a relatively rare anatomical variation that is frequently associated with a biliary system anomaly
A flexible and optimal port site should be inserted in cases of left-sided gallbladder with acute cholecystitis
The round ligament was attached to the right umbilical portion, which was associated with the anomaly of the intrahepatic portal vein system (Fig. 2)
Summary
Several reports showed that intrahepatic portal vein and biliary system anomalies are rather common in cases of LSG [1, 7]. Our previous report demonstrated that the preoperative detection of LSG is important for avoiding biliary injury in cases of hepatectomy [8]. The anomaly of the intrahepatic portal system was detected preoperatively, but the diagnosis of LSG was made according to intraoperative findings. In cases of acute cholecystitis, it is important to pay attention to the formation of a right umbilical portion as well as the preoperative location of a round ligament to distinguish between LSG and gallbladder torsion. Radiological findings are similar to gallbladder torsion, but identification of the round ligament is useful for the diagnosis of LSG.
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