Left-sided gallbladder missed on ultrasonography: a case series and proposed intraoperative strategy

Left-sided gallbladder (LSG) is a rare congenital anomaly that may not be detected by routine ultrasonography. Although uncommon, it has important implications for surgical safety due to associated variations in biliary anatomy.

We report three patients with symptomatic cholelithiasis in whom preoperative ultrasonography suggested normal anatomy. In all cases, LSG was identified intraoperatively. Two patients underwent successful laparoscopic cholecystectomy following careful anatomical reassessment, while one required conversion to open surgery due to difficulty in safely identifying biliary structures.

These cases highlight the limitations of ultrasonography in identifying positional anomalies and emphasize the importance of intraoperative awareness. LSG can distort the usual anatomical landmarks and increase the risk of bile duct injury. A careful, anatomy-first approach is essential when such variations are encountered.

Normal ultrasonography does not exclude anatomical variation. Safe surgical outcomes depend on early recognition, cautious dissection, and sound intraoperative judgment.