Malrotation of Liver and Porta Hepatic Structures Encountered during Laparoscopic Cholecystectomy- Case Report

Abstract

Ever since the start of study of anatomy there have been numerous anatomical variations or aberrations that have been reported for gall bladder, cystic artery, cystic duct, hepatic artery, common bile duct and portal vein. Performing surgeries with laparoscope provides magnified image, thereby allowing a better vision and understanding of the local anatomy of the gall bladder, calot's triangle and porta hepatis. Cholecystectomy requires keen observation and meticulous dissection. Even the most experienced surgeons have encountered complications during laparoscopic cholecystectomy owing to the anatomical variations. Here is a case report of a 36 year old lady presenting with acute calculous cholecystitis. She was taken up for laparoscopic cholecystectomy. Only the fundus of the gall bladder was seen. Gall bladder was to the left of falciform ligament. During dissection there was sudden gush of blood which could not be controlled, hence converted to open surgery. There was malrotation of the liver causing falciform ligament to be at the right of gall bladder. There was malrotation at the porta with portal vein anterior to common bile duct and hepatic artery and anomalous portal vein being the site of bleeding. Unpredictability of the structures at porta and gall bladder anatomy is a predicament requiring furthermore understanding.