Hartmann pouch herniation in Calot's triangle: A case report

Laparoscopic cholecystectomy is one of the most frequent operations performed around the world. Some pathological findings are particularly rare and difficult to diagnose preoperatively. Here, we report a case of a patient who presented to our hospital with calculus cholecystitis with a unique Intraoperative finding of Hartmann pouch herniation through hepatocystic triangle. The aim of the study is to consider Hartmann pouch herniation as a rare differential diagnosis of gallbladder stone complication.

We present a 48-year-old male who came to our emergency department complaining of constant epigastric abdominal pain lasting 3 h with vomiting. Utilizing chemistry laboratory studies and radiological studies, the final diagnosis was acute calculus cholecystitis. Early laparoscopic cholecystectomy was done and revealed Hartmann pouch herniation through the Calot's triangle. This herniation resulted in strangulation of the Hartmann pouch and displacement of the cystic duct and artery anteriorly.

The biliary tract is liable for congenital anomalies. These anatomical variations can be diagnosed either intra-operatively or pre-operatively using radiological imaging. Hartmann pouch herniation is a new finding that we encountered in this case.

Profound surgeons' anatomical knowledge is essential for the safety of patients, especially for hepatobiliary surgeries due to the wide variations in normal and pathological anatomy. Using critical view of safety can decrease avoidable complications. Consulting specialized hepatobiliary surgeon is preferred when dealing with such cases.