BackgroundLaparoscopic cholecystectomy (LC) has traditionally been performed under general anesthesia, however, owing in part to the advancement of surgical and anesthetic techniques, many laparoscopic cholecystectomies have been successfully performed under the spinal anesthetic technique. We hoped to determine the feasibility of segmental epidural anesthesia for LC.MethodsTwelve American Society of Anesthesiologists class I or II patients received an epidural block for LC. The level of epidural block and the satisfaction score of patients and the surgeon were checked to evaluate the efficacy of epidural block for LC.ResultsLC was performed successfully under epidural block, with the exception of 1 patient who required a conversion to general anesthesia owing to severe referred pain. There were no special postoperative complications, with the exception of one case of urinary retention.ConclusionsEpidural anesthesia might be applicable for LC. However, the incidence of intraoperative referred shoulder pain is high, and so careful patient recruitment and management of shoulder pain should be considered.

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Congenital fusion of the atlas with the odontoid process of the axis is a very rare condition caused by a segmental defect of the first cervical somite. Only 9 such cases have been reported in the literature to date. The bipartite atlas, another well-documented rare anomaly, has been observed in only 0.1% of the general population. We describe the first case of a 70-year-old male with both of these complex congenital anomalies.