Abstract:

A 47-year-old man who presented with epigastric pain after a meal was diagnosed with biliary sludge present in the gallbladder. Endoscopic retrograde cholangiopancreatography showed normal anatomy of the biliary tree. During the exploratory phase of a laparoscopic cholecystectomy using four ports positioned as usual, surgeons observed a left-sided gallbladder. A review of the preoperative imaging by computed tomography confirmed a round ligament connected to the right portal umbilical portion. It also established that the gallbladder was located to the left of the round ligament, and attached to the left lateral segment of the liver. Laparoscopic cholecystectomy was performed successfully in this patient with the usual port site and careful dissection with a normograde approach. The patient was discharged on the second postoperative day with an uneventful course. Prior identification of a left-sided gallbladder is possible with cautious attention. In particular, it is important for the surgeon to be aware of unusual alterations in the portal and biliary anatomy associated with this anomaly to safely complete a laparoscopic cholecystectomy.

Authors:

Tsutomu Namikawa, MD, PhD, Associate Professor, Department of Surgery, Kochi Medical School, Nankoku, Japan, Kohei Tamura, MD, Consultant Surgeon, Department of Surgery, Susaki Kuroshio Hospital, Susaki, Japan, Masao Morita, MD, PhD, Chief, Department of Surgery, Susaki Kuroshio Hospital, Susaki, Japan, Seihei Tamura, MD, PhD, Director, Department of Surgery, Susaki Kuroshio Hospital, Susaki, Japan, Hiromichi Maeda, MD, PhD, Assistant Professor, Department of Surgery, Kochi Medical School Hospital, Nankoku, Japan, Michiya Kobayashi, MD, PhD, Professor, Department of Surgery, Kochi Medical School, Nankoku, Japan, Kazuhiro Hanazaki, MD, PhD, Professor, Department of Surgery, Kochi Medical School, Nankoku, Japan, Takashi Usui, MD, PhD, Director, Department of Surgery, Tano Hospital, Tano-cho, Japan

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