Subhepatic gallbladder: an extremely rare anatomical variant challenging the laparoscopic surgeon

Gallbladder anatomical variations are common, but positional anomalies such as subhepatic gallbladder are exceedingly rare. Recognition of these variants is crucial for preventing iatrogenic bile duct injury during laparoscopic cholecystectomy. A 35-year-old medically free male presented with a 3-day history of epigastric pain associated with nausea, vomiting, and dark urine. Laboratory investigations revealed elevated liver enzymes and hyperbilirubinemia. Ultrasonography showed gallstones with a dilated common bile duct. Magnetic resonance cholangiopancreatography (MRCP) demonstrated a subhepatic gallbladder containing multiple stones, an impacted neck stone, and a distal common bile duct (CBD) stone. Endoscopic retrograde cholangiopancreatography with sphincterotomy and stone extraction was performed, followed by stent placement. Laparoscopic cholecystectomy revealed the gallbladder in a subhepatic position surrounded by dense adhesions. Dissection of Calot's triangle was carefully performed to identify and secure the cystic duct and artery. The procedure was completed successfully, and the patient's postoperative recovery was uneventful. He was discharged home on postoperative Day 1 with improved liver function. Subhepatic gallbladder is a rare congenital anomaly that can mimic typical biliary disease but complicate surgical anatomy. Preoperative MRCP is invaluable in detecting such anomalies, guiding operative planning, and minimizing bile duct injury risk. Awareness of positional variations enhances surgical safety and decision-making. Preoperative imaging and intraoperative vigilance are essential when encountering atypical gallbladder anatomy. This case underscores the importance of anticipating anatomical variations to achieve safe and effective laparoscopic cholecystectomy.