Left-Sided Gallbladder in the Absence of Situs Inversus: Case Report and Surgical Implications

Area of Science:

• Surgical Anatomy
• Gastrointestinal Surgery
• Congenital Anomalies

Background:

• Sinistroposition of the gallbladder (SPGB) is a rare congenital anomaly where the gallbladder is located left of the falciform ligament without situs inversus.
• This anomaly can complicate laparoscopic cholecystectomy due to altered biliary anatomy and increased risk of bile duct injury.
• Preoperative imaging often fails to detect SPGB.

Purpose of the Study:

• To report a case of sinistroposition of the gallbladder diagnosed intraoperatively during laparoscopic cholecystectomy.
• To emphasize the importance of recognizing SPGB and adhering to safe surgical principles to prevent complications.

Main Methods:

• A case report of a 53-year-old woman undergoing laparoscopic cholecystectomy for symptomatic cholelithiasis.
• Intraoperative identification of the gallbladder to the left of the round ligament, consistent with SPGB.
• Application of Critical View of Safety during dissection.

Main Results:

• The gallbladder was found in the left upper quadrant, consistent with SPGB.
• Laparoscopic cholecystectomy was completed successfully without intraoperative complications or need for cholangiography.
• The patient had an uneventful recovery and remained asymptomatic.

Conclusions:

• SPGB is a rare variant often diagnosed intraoperatively.
• Strict adherence to safe cholecystectomy techniques, especially the Critical View of Safety, is vital for preventing bile duct injury in SPGB.
• Advanced imaging may aid in preoperative diagnosis and surgical planning.