Left-sided gall bladder: From surprise to safe exit

Left-sided gall bladder (LSGB) is a rare anatomical variant that increases the risk of bile duct injury, particularly when combined with other gall bladder pathology. A 57-year-old male with a several-year history of intermittent post-prandial epigastric pain had hepatic steatosis and gall bladder polyps (largest 9 mm) on ultrasound, and hepatobiliary scintigraphy showed a reduced gall bladder ejection fraction consistent with biliary dyskinesia. Elective laparoscopic cholecystectomy was performed; at laparoscopy, the gall bladder was unexpectedly located to the left of the falciform ligament, confirming true LSGB. Ports were placed slightly lower than usual, and an epigastric port was alternated across the falciform ligament. Intraoperative ultrasound delineated a short cystic duct entering the common hepatic duct, and the critical view of safety was obtained. The cystic duct and artery were clipped close to the gall bladder, which was removed without bile spillage; recovery was uneventful and histology showed chronic cholecystitis without dysplasia. True LSGB with polyps and biliary dyskinesia can be managed safely by laparoscopy when surgeons adhere to the critical view of safety and use adjunctive imaging.