Left-Sided Gallbladder Discovered During Laparoscopic Cholecystectomy in a Patient with Dextrocardia

Abstract

Left-sided gallbladder, a rare congenital anomaly, is often associated with transposition of single or multiple viscera of thorax and/or abdomen. Clinical features and routine presurgical ultrasonography could miss the anomalous position thereby producing unnecessary anxiety during surgery. Here we are reporting a patient with leftsided gallbladder, known to have dextrocardia with multiple intracardiac anomalies, and detected incidentally in a series of 1258 consecutive laparoscopic cholecystectomies. Laparoscopic cholecystectomy was performed successfully in this patient with port site modification and careful dissection. Some degree of abdominal visceral situs inversus is to be anticipated in patients with dextrocardia

Left‐sided gallbladder: a systematic review of a rare biliary anomaly

“…57,58 The surgeon's left-hand 5-mm operating port may be placed 5-6 cm more medially with their right-hand 10-mm port in the left upper quadrant midclavicular line. 27,50,52 An alternative port placement is the epigastric port passed to the left of the falciform ligament and the other 5-mm dissecting port in the left side of the abdomen. 14,15,58 Two techniques involving the falciform ligament were described.…”

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

“…Patients commonly present right upper quadrant discomfort, [8] pain radiating to the right flank [9] and positive Murphy’s sign. [10] Therefore, signs and symptoms could be misleading [8] and the diagnosis might be missed.…”

“…[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.…”

“…[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. [10]…”

“…[9], [12], [19] Others suggest use of accessory ports. [2], [8], [20] Moreover, a single-incision at the umbilicus with insertion of two ports; one for the camera and one for working is suggested. [3] Another choice suggested, is minor modification to the entry sites of the trocars, [10] as performed in the present case, with a minimal modification of the entry site of the subxiphoid trocar.…”