Surgical approach to a left-sided gallbladder

Abstract

Biliary colic is a pain in the right upper quadrant or epigastrium thought to be caused by functional gallbladder spasm from a temporary obstructing stone in the gallbladder neck, cystic duct or common bile duct. A 56-year-old man presented with frequent episodes of typical biliary colic. At initial laparoscopy, the gallbladder was absent from its anatomic location. Further inspection revealed a left-sided gallbladder (LSGB), suspended from liver segment 3. Preoperative ultrasound, the most common imaging modality for symptomatic gallstones, has a low positive predictive value for detecting LSGB (2.7%). Laparoscopic cholecystectomy (LC) was delayed to attain additional imaging. A magnetic resonance cholangiopancreatography demonstrated the gallbladder left of the falciform ligament with the cystic duct entering the common hepatic duct from the left. The patient underwent an elective LC 8 weeks later. The critical view of safety is paramount to safe surgical dissection and could be safely achieved for LSGB.

Subtotal cholecystectomy as an approach to preventing injury in the left-sided gallbladder in the emergency surgery setting: A case study

“…First, pre-operative identification of the left-sided gallbladder is difficult, especially in emergency admission patients whose radiological investigations are restricted to a real-time ultrasound scan of the gallbladder [17]. Table 1 describes why it is difficult to reveal a left-sided gallbladder through standard examination and imaging techniques before surgery [3,[18][19][20][21][22]. On the contrary, a left-sided gallbladder and the variations of the biliary tract -a frequent combination of biliary anomalies -can be diagnosed preoperatively using intravenous contrast-enhanced reconstructive three-dimensional computed tomography (CT)-cholangiography [23][24][25].…”

Gallbladder Position Anomalies: Clinical Impacts and Management

“…Cystic duct anomalies in left-sided gallbladder may involve the cystic duct joining the right hepatic duct in 7.6% of cases, the left hepatic duct in 9.5% of cases, and the accessory duct in 2.4% of cases. The cystic duct joins the CBD from the right side in 65% of cases and from the left side in 9.5% of cases [42]. Other associated anomalies may include bile duct duplication, bile duct confluence in the umbilical fissure located to the left of the umbilical portion of the portal vein, and preduodenal portal vein, hepatic artery, and CBD anomalies.…”

“…Typically, patients undergo preoperative US that detects gallbladder stones but fails to detect the position anomaly. Whenever cystic lesion are found in an atypical location and the gallbladder is not found in its normal location, the possibility of ectopic gallbladder should be considered and computed tomography (CT) or MRCP evaluation should be performed [18,26,[40][41][42]. CT will show the gallbladder located to the left of the round ligament with a positive predictive value of 60% [18].…”

“…Histopathological study shows hemorrhagic necrosis. The gold standard for surgical management is laparoscopic cholecystectomy [6,14,15,40,42]. However, in the absence of expertise and…”

“…If the gallbladder is adjacent to the transverse colon on CT scan, MRCP should be considered to confirm diagnosis of mesocolic gallbladder. Laparoscopic cholecystectomy with technical modification is a safe procedure, but surgeons should always keep in mind the possibility of conversion to open cholecystectomy [6,15,16,40,42].…”