Cholecystitis in a midline gallbladder: A rare ectopic location

The ectopic gallbladder is an uncommonly encountered anomaly that surgeons should be aware of. Its diagnosis is difficult but can be elucidated with the use of computed tomography and MRCP.

We present a case of a 64-year-old patient who presented with abdominal pain, inflammatory epigastric mass and fever. Computed tomography (CT) revealed the presence of a para-umbilical gallbladder with signs of acute cholecystitis. Laparoscopic exploration revealed that the gall bladder was not present in its usual fossa but was seen attached to the midline anterior abdominal wall with extensive adhesion between it and the omentum. Given the complexity of the cholecystectomy via the laparoscopic approach, a conversion to a midline incision was performed. The IOC confirmed the absence of anatomical variants of the biliary tree.

An ectopic gallbladder is a difficult entity to diagnose as it can create clinical confusion by tampering with the common clinical presentation of cholecystitis. MRCP is currently one of the most effective preoperative examination methods as it detects the coexistence of biliary tract variation. Laparoscopic surgery is a safe procedure to be performed in the ectopic gallbladder.

Ectopy of the gallbladder is a rare congenital abnormality that should be kept in mind to avoid errors or delays in management.