Related Experiment Videos
Left-sided gallbladder: a complicated percutaneous cholecystostomy and subsequent hepatic embolisation
1Department of Diagnostic Radiology, Bongsaeng Memorial Hospital, Busan, Korea. jhs0620@dreamwiz.com
Insights
A left-sided gallbladder diagnosis is crucial for safe percutaneous cholecystostomy. This case highlights how identifying gallbladder anomalies prevents complications like hepatic injury during the procedure.
Area of Science:
- Gastroenterology
- Surgical Anatomy
Background:
- A 68-year-old male with comorbidities presented with acute calculous cholecystitis.
- Standard treatment involves percutaneous cholecystostomy, especially in high-risk patients.
Observation:
- Two attempts at percutaneous cholecystostomy via a transhepatic approach failed.
- A transperitoneal approach was ultimately successful.
- The patient developed haemoperitoneum due to hepatic injury post-procedure.
- Laparoscopic cholecystectomy revealed a left-sided gallbladder anomaly.
Findings:
- The left-sided gallbladder was the cause of the failed transhepatic attempts and subsequent hepatic injury.
- The transperitoneal approach proved feasible and potentially preferable for this anomaly.
Implications:
- Pre-procedural imaging to identify gallbladder anomalies is critical for patient safety.
- Awareness of situs inversus or left-sided gallbladder can guide surgical approach selection.
- This case suggests the transperitoneal route may be advantageous for left-sided gallbladder percutaneous cholecystostomy.
Abstract:
A 68-year-old male patient with chronic hypertension, diabetes mellitus and chronic renal failure was diagnosed with acute calculous cholecystitis. A percutaneous cholecystostomy using a transperitoneal approach was performed after two failed attempts with a right-sided transhepatic approach. Subsequent hepatic embolisation was performed for the treatment of haemoperitoneum due to hepatic injury after the percutaneous cholecystostomy. The presence of a left-sided gallbladder was confirmed by laparoscopic cholecystectomy after 1 week. Prior identification of this anomaly would have prevented hepatic injury through the use of a cautious procedure against mobility or careful selection of the approach routes. In conclusion, the transperitoneal approach can be easier or more preferable to perform for a percutaneous cholecystostomy of a left-sided gallbladder.
