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Surgical approach to a left-sided gallbladder.

Ryan Pereira1,2, Marlon Perera1, Matthew Roberts1

  • 1Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.

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Biliary colic can be caused by a rare left-sided gallbladder (LSGB), which is difficult to detect with ultrasound. Safe laparoscopic cholecystectomy is achievable with proper imaging and surgical technique.

Keywords:
biliary interventiongeneral surgerypancreas and biliary tract

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Area of Science:

  • Gastroenterology
  • Surgical Anatomy
  • Medical Imaging

Background:

  • Biliary colic is typically associated with gallstones obstructing the gallbladder or bile ducts.
  • Anatomical variations of the gallbladder can complicate diagnosis and surgical management.
  • Left-sided gallbladder (LSGB) is a rare congenital anomaly.

Observation:

  • A 56-year-old male presented with symptoms of biliary colic.
  • Initial laparoscopy revealed an absent gallbladder in the expected location.
  • A left-sided gallbladder (LSGB) was identified, suspended from liver segment 3.

Findings:

  • Preoperative ultrasound demonstrated a low positive predictive value (2.7%) for LSGB detection.
  • Magnetic resonance cholangiopancreatography confirmed the LSGB's left-sided position and cystic duct anatomy.
  • The patient successfully underwent laparoscopic cholecystectomy for LSGB.

Implications:

  • LSGB presents diagnostic challenges, often missed by standard preoperative imaging like ultrasound.
  • Advanced imaging, such as MRCP, is crucial for preoperative planning of LSGB cases.
  • Safe laparoscopic cholecystectomy for LSGB is feasible, emphasizing the importance of the critical view of safety during dissection.