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Hawkins N, Ben David M. Left-Sided Gallbladder: Tips and Tricks to Safe Cholecystectomy. Cureus 2024; 16:e76503. [PMID: 39872591 PMCID: PMC11771096 DOI: 10.7759/cureus.76503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2024] [Indexed: 01/30/2025] Open
Abstract
Left-sided gallbladder (LSGB) is a rare anatomical variation where the gallbladder is to the left of the falciform ligament and ligamentum teres. Most commonly, it is discovered as an incidental finding at the time of operation (typically for cholecystectomy). We describe a case of left-sided gallbladder in a 71-year-old female. The patient presented with complaints of pain in the right upper quadrant and epigastric area, which had persisted for two months, accompanied by intermittent biliary colic over the previous five years. An ultrasound demonstrated a single 39 mm gallstone. She underwent an elective laparoscopic cholecystectomy, during which an incidental discovery of an LSGB occurred. Patients with LSGB have a relatively high risk of complications when proceeding with operative interventions, likely secondary to concurrent biliary and arterial anatomical variants. Images of the anatomy of LSGB and possible adaptations to the usual laparoscopic cholecystectomy techniques necessary to perform a safe operation are discussed, including division of the falciform ligament and altered port placements. LSGB is a rare anatomical variation that increases surgical risk at the time of cholecystectomy. Understanding this variation in anatomy is critical to undertaking safe operative interventions in these patients.
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Affiliation(s)
- Nicole Hawkins
- General Surgery, Townsville University Hospital, Townsville, AUS
| | - Matan Ben David
- Hepatobiliary Surgery, Mater Misericordiae University Hospital, Townsville, AUS
- Hepatobiliary Surgery, Townsville University Hospital, Townsville, AUS
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2
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Almas T, Murad MF, Mansour E, Khan MK, Ullah M, Nadeem F, Shafi A, Khedro T, Almuhaileej M, Abdulhadi A, Alshamlan A, Nagarajan VR, Mansoor E. Look, but to the left: A rare case of gallbladder sinistroposition and comprehensive literature review. Ann Med Surg (Lond) 2021; 71:103016. [PMID: 34840764 PMCID: PMC8606894 DOI: 10.1016/j.amsu.2021.103016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 10/31/2021] [Accepted: 10/31/2021] [Indexed: 11/29/2022] Open
Abstract
Left-sided gallbladder (LSGB) is a rare anatomic variation that, while benign in the context of its transposition, is of significant intraoperative importance. Due to its association with other anatomic anomalies involving key structures in the hepatobiliary system, discovering it intraoperatively as opposed to preoperatively suddenly increases the difficulty of a gallbladder procedure.
Left-sided gallbladder (LSGB) is a rare anatomic variation that, while benign in the context of its transposition, is of significant intraoperative importance. Although laparoscopic cholecystectomy of a LSGB is safe, it is associated with higher risk of complications such as common bile duct injury. Most cases of a LSGB are diagnosed intraoperatively, and this sudden discovery during the procedure can increase the difficulty, duration, and stress of the procedure due to the other potential anatomic anomalies that LSGB is associated with in the hepatobiliary system.
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Affiliation(s)
- Talal Almas
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Eyad Mansour
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Muneeb Ullah
- Department of Surgery, Maroof International Hospital, Islamabad, Pakistan
| | - Faisal Nadeem
- Department of Surgery, Maroof International Hospital, Islamabad, Pakistan
| | - Adil Shafi
- Department of Surgery, Maroof International Hospital, Islamabad, Pakistan
| | - Tarek Khedro
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | | | - Emad Mansoor
- Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
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Pereira R, Singh T, Avramovic J, Baker S, Eslick GD, Cox MR. Left-sided gallbladder: a systematic review of a rare biliary anomaly. ANZ J Surg 2019; 89:1392-1397. [PMID: 30836441 DOI: 10.1111/ans.15041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 10/31/2018] [Accepted: 12/05/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND A left-sided gallbladder (LSGB) is a rare anatomical anomaly that is often not discovered until surgery. Two cases of LSGB managed with laparoscopic cholecystectomy (LC) stimulated this systematic review. The aims of this study were in LSGB to define the rate of pre-operative detection, variations in biliary anatomy, laparoscopic techniques employed and outcomes of surgery for symptomatic gallstones. METHODS A systematic review was performed using Preferred Reporting Items for Systematic reviews and Meta-Analyses principles. RESULTS Fifty-three studies with 112 patients of which 90 (80.4%) had symptomatic gallstones. Pre-operative imaging was performed in 108 patients (96.4%) with an LSGB reported on imaging in 32 (29.6%) patients. The remainder of LSGB were discovered at surgery. Ultrasound detected an LSGB in three (2.7%) patients. Five variants of cystic union with the common hepatic duct (CHD) were identified. The most common (67.8%) was union on the right side of the CHD after a hairpin bend anterior to the CHD. A cholecystectomy for gallstone disease was performed in 90 patients, 23.3% open and 76.7% LC. Common variations in LC technique were different port site placement and techniques related to the falciform ligament to improve exposure. Common bile duct injury occurred in four (4.4%) patients. CONCLUSION LSGB is a rare anatomical variation that in patients with symptomatic gallstones is usually discovered at surgery. Cholecystectomy is associated with a higher incidence of common bile duct injury.
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Affiliation(s)
- Ryan Pereira
- North Queensland Minimally Invasive Surgery, Mater Medical Centre, Sydney, New South Wales, Australia
- The Whiteley-Martin Research Unit, Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia
| | - Talbir Singh
- North Queensland Minimally Invasive Surgery, Mater Medical Centre, Sydney, New South Wales, Australia
| | - John Avramovic
- North Queensland Minimally Invasive Surgery, Mater Medical Centre, Sydney, New South Wales, Australia
| | - Sam Baker
- North Queensland Minimally Invasive Surgery, Mater Medical Centre, Sydney, New South Wales, Australia
| | - Guy D Eslick
- The Whiteley-Martin Research Unit, Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael R Cox
- The Whiteley-Martin Research Unit, Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia
- Department of Surgery, Nepean Hospital, Sydney, New South Wales, Australia
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Banchini F, Ekpo EF, Conti L, Capelli P. Left side gallbladder with agenesis of right anterior sector and absence of right hepatic duct. A case report. Int J Surg Case Rep 2019; 60:249-252. [PMID: 31255935 PMCID: PMC6610679 DOI: 10.1016/j.ijscr.2019.06.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/02/2019] [Accepted: 06/17/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Left sided gallbladder is a rare congenital abnormality more often discovered as incidental finding during laparoscopic cholecystectomy requiring surgical challenge to prevent complication. We present a case of a true left sided gallbladder treated with laparoscopic cholecystectomy. CASE A 90 y/o woman with acute abdominal pain was hospitalised and underwent a laparoscopic cholecystectomy. A preoperative CT scan didn't show the variation. Intraoperative finding revealed a true left sided gallbladder that was carefully dissected at the Calot's triangle with identification of the cystic duct and artery. After a complete separation of the gallbladder from the liver, the cystic duct and the artery were safely clipped and transected. CT scan reconstruction reveal agenesis of the right superior sector with simultaneous absence of the right biliary duct. DISCUSSION True left sided gallbladder is defined as one attached in the left of the ligamentum teres and falciform ligament. This abnormality predispose to a numerous anatomical variation. Unfortunately its finding is more often incidentally during intervention and recognition of such variation could be difficult that can be of high risk for surgical injury. CONCLUSION Left sided gallbladder presents a significant challenge to the surgeon and makes it even more difficult to avoid postoperative complications. Therefore, a careful dissection of Calot's triangle and the complete mobilisation of the gallbladder should be done before clipping the cystic duct and artery. However, if a preoperative finding suggests a left sided gallbladder, then an in-depth preoperative anatomical study is advocated.
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Affiliation(s)
- Filippo Banchini
- Department of General Surgery, Guglielmo da Saliceto Hospital, Piacenza, Italy.
| | | | - Luigi Conti
- Department of General Surgery, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Patrizio Capelli
- Department of General Surgery, Guglielmo da Saliceto Hospital, Piacenza, Italy
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Nguyen TH, Nguyen TS, Van Nguyen PD, Dang TN, Talarico EF. Sinistroposition: A case report of true left-sided gallbladder in a Vietnamese patient. Int J Surg Case Rep 2018; 51:82-85. [PMID: 30149330 PMCID: PMC6111038 DOI: 10.1016/j.ijscr.2018.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 08/13/2018] [Indexed: 02/07/2023] Open
Abstract
Left-sided gallbladder without situs viscerum inversus is a rare congenital anomaly. Left-sided gallbladder is accompanied by anatomic variations: portal vein and/or biliary system anomalies, segment IV atrophy, variations in hepato-biliary vascular anatomy. Left-sided gallbladder can present significant intraoperative challenges due to associated variations in ductal and vessel anatomy. There are three proposed, embryologic mechanisms for Left-sided gallbladder without situs viscerum inversus. Even the face of routine preoperative testing, ultrasound, and CT scan, left-sided gallbladder often remains undetected until surgery. Laparoscopic antegrade cholecystectomy can be performed safely for left-sided gallbladder. Introduction Left-sided gallbladder without situs viscerum inversus (LSG-woSVI) is defined as a gallbladder located under the left lobe of the liver; to the left of the round/falciform ligament, but with all other viscera maintaining normal anatomical relationships. This is a rare congenital anomaly with a reported prevalence that ranges from 0.04% to 1.1%. It is usually an incidental intraoperative finding, and can be associated with anatomic abnormalities of the biliary tree, portal system and vasculature. LSG and associated variations may present significant challenges even for experienced surgeon. Presentation of case LSG-woSVI was unexpectedly discovered in a 49-year-old, Vietnamese female during laparoscopic cholecystectomy. There were no pre-operative indications of sinistroposition. The cystic duct joined the common hepatic duct on the right side, and the cystic artery crossed anterior to the common bile duct in a right-to-left direction. Antegrade cholecystectomy was performed without intraoperative or postoperative complications. Discussion LSG is a rare anatomical variation that often remains undetected with ultrasound and pre-operative tests. Several hypotheses suggest underlying embryologic mechanisms for LSG and associated anomalies in ductal, portal and vascular anatomy, but the exact cause remains a mystery. Safe laparoscopic cholecystectomy can be done; however, there is an increased risk of injury to the major biliary structures compared to orthotopic gallbladder. Conclusion Laparoscopic antegrade cholecystectomy is feasible for LSG. However, surgeons need to be cognizant of anatomy, so that rapid modifications of surgical technique can ensure positive patient outcomes.
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Affiliation(s)
- Tri Huu Nguyen
- Anatomy Department, Hue University of Medicine and Pharmacy, Hue, Việt Nam
| | - Tung Sanh Nguyen
- Anatomy Department, Hue University of Medicine and Pharmacy, Hue, Việt Nam
| | | | - Thanh Nhu Dang
- Surgery Department, Hue University of Medicine and Pharmacy, Hue, Việt Nam
| | - Ernest F Talarico
- Department of Anatomy & Cell Biology, Indiana University School of Medicine-Northwest, Dunes Medical Professional Building, Room 3028A, 3400 Broadway, Gary, IN, 46408-1197, USA.
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Saafan T, Hu JY, Mahfouz AE, Abdelaal A. True left-sided gallbladder: A case report and comparison with the literature for the different techniques of laparoscopic cholecystectomy for such anomalies. Int J Surg Case Rep 2017; 42:280-286. [PMID: 29331884 PMCID: PMC5771968 DOI: 10.1016/j.ijscr.2017.12.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 12/08/2017] [Accepted: 12/12/2017] [Indexed: 02/07/2023] Open
Abstract
True LSG is a rare anomaly that may present with right-sided abdominal symptoms and may be missed by preoperative imaging. Though right-sided ports are feasible in LSG, modifications to surgical technique may be done for safe dissection. Meticulous dissection of the gallbladder border is necessary to avoid injury to surrounding tissues. Introduction True left-sided gallbladder (LSG) is a rare finding that may present with symptoms similar to those of a normally positioned gallbladder. Moreover, it may be missed by preoperative imaging studies such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), or endoscopic ultrasound. True left-sided gallbladder is a surgical challenge and surgical technique may need to be modified for the completion of laparoscopic cholecystectomy. Presentation of case In this case report, we present a case of true left-sided gallbladder that produced right-sided abdominal symptoms. Ultrasound of the abdomen failed to show the left-sided position of the gallbladder. MRI showed the gallbladder located to the left of the ligamentum teres underneath segment III of the liver. Intraoperatively, the gallbladder was grasped and retracted to the right under the falciform ligament and it was removed using classical right-sided ports with no modification to the technique. No complications were encountered intraoperatively or postoperatively. Discussion True LSG is a rare anomaly that may present with right-sided symptoms like normally positioned gallbladder. It may be missed in preoperative imaging studies and can be discovered only intraoperatively. Modification of laparoscopic ports, change in patient’s position and/or surgeon’s position, or conversion to open cholecystectomy may be needed for safe removal of the gallbladder. Conclusion Classical technique of laparoscopic cholecystectomy is feasible for left-sided gallbladder. However, if the anatomy is not clear, modifications of the surgical technique may be necessary for the safe dissection of the gallbladder.
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Affiliation(s)
- Tamer Saafan
- General Surgery Department, Hamad General Hospital, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar.
| | - James Yi Hu
- Weill Cornell Medicine - Qatar, Qatar Foundation - Education City, P.O. Box 24144, Doha, Qatar
| | - Ahmed-Emad Mahfouz
- Radiology Department, Hamad General Hospital, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | - Abdelrahman Abdelaal
- General Surgery Department, Hamad General Hospital, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
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Abongwa HK, De Simone B, Alberici L, Iaria M, Perrone G, Tarasconi A, Baiocchi G, Portolani N, Di Saverio S, Sartelli M, Coccolini F, Manegold JE, Ansaloni L, Catena F. Implications of Left-sided Gallbladder in the Emergency Setting: Retrospective Review and Top Tips for Safe Laparoscopic Cholecystectomy. Surg Laparosc Endosc Percutan Tech 2017; 27:220-227. [PMID: 28614170 DOI: 10.1097/sle.0000000000000417] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Left-sided gallbladder without situs viscerum inversus (LSG-woSVI) is a rare congenital anomaly. Clinical features and routine presurgical imaging could miss the anomalous position, thereby producing complications during surgery. Laparoscopic cholecystectomy can be performed safely, but the risk of bile duct injury (BDI) is greater than in cholecystectomy of the orthotopic gallbladder. We present a retrospective review of all scientific literature for diagnosed cases of LSG-woSVI undergoing cholecystectomy from 1996 to 2014. Our objectives were to outline empirical top tips for a safe cholecystectomy in incidentally diagnosed LSG-woSVI. METHODS We carried a comprehensive search of PubMed using medical subject headings "left-sided gallbladder," "right-sided ligamentum teres" "situs viscerun inversus," "preoperative diagnoses," "cholecystectomy," and "bile duct injury." We considered a classification of the LSG-woSVI in 2 groups: True LSG-woSVI and LSG-woSVI in patients with right-sided ligamentum teres. RESULTS Our retrospective review revealed 55 cases of LSG-woSVI. The mean age was 51 years ±17 SD, male/female ratio was 2:1, clinical presentation was pain in the right upper abdominal quadrant in 75.5%, preoperative diagnosis was reached in 16.3%, True LSG was diagnosed in 83%, acute cholecystitis was found in 50%, laparoscopic cholecystectomy was performed in 79.6%, fundus-first dissection technique was used in 16.7%, intraoperative cholangiography was performed in 39.1%, and BDI occurred in 7.3% of the reported cases. CONCLUSIONS Increased awareness of the anatomic aberrations in LSG-woSVI associated with improved preoperative diagnosis and a good knowledge about safe surgical techniques for cholecystectomy could indubitably reduce the incidence of BDI.
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Affiliation(s)
- Hariscine K Abongwa
- *Department of Emergency and Trauma Surgery, Parma University Hospital, Parma †Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, Brescia ‡Department of Emergency and Trauma Surgery, Maggiore Hospital-Bologna Local Health District, Bologna §Departmente of Surgery, Macerata Hospital, Macerata ∥Unit of General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy ¶David Geffen School of Medicine, University of California, Los Angeles, CA
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Zoulamoglou M, Flessas I, Zarokosta M, Piperos T, Papapanagiotou I, Birbas K, Konstantinou E, Mariolis-Sapsakos T. Left-sided gallbladder (Sinistroposition) encountered during laparoscopic cholecystectomy: A rare case report and review of the literature. Int J Surg Case Rep 2017; 31:65-67. [PMID: 28110174 PMCID: PMC5247567 DOI: 10.1016/j.ijscr.2017.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 01/05/2017] [Accepted: 01/05/2017] [Indexed: 01/28/2023] Open
Abstract
LSG is a peculiar anatomical variation that is difficult to be identified preoperatively. LSG is associated with anatomical anomalies that may lead to intra-operative injuries. Safe laparoscopic cholecystectomy is feasible by placing the patient to left-side up position for better exposure of the operative field. Introduction True Left-sided gallbladder (LSG) is a rare anatomical variation with a prevalence of 0.3%. Mainly discovered during the operation, its surgical approach in the laparoscopic setting may be challenging even for an experienced surgeon. Presentation of case LSG was unexpectedly discovered in a young man during laparoscopic cholecystectomy. There were no pre-operative indications of this sinistroposition. The laparoscopic cholecystectomy was performed with minor surgical modifications and it was uneventful. A meticulous review of recent literature about LSGs was conducted as well. Discussion LSG is a scarce anatomical aberration that is difficultly identified pre-operatively. Surgeons should be aware of this aberration and of its accompanying anatomical variations in order to perform a safe laparoscopic cholecystectomy. Conclusion Surgeons, by placing the patient to left-side up position, are able to expose the Calot’s triangle and possible accompanying anatomical anomalies and thus perform a safe laparoscopic cholecystectomy without difficult surgical modifications.
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Affiliation(s)
- Menelaos Zoulamoglou
- University Department of Surgery, General and Oncologic Hospital of Kifissia "Agii Anargiri", Athens, Greece
| | - Ioannis Flessas
- Anatomy and Histology Laboratory, Nursing School, University of Athens, Greece
| | - Maria Zarokosta
- University Department of Surgery, General and Oncologic Hospital of Kifissia "Agii Anargiri", Athens, Greece; Anatomy and Histology Laboratory, Nursing School, University of Athens, Greece.
| | - Theodoros Piperos
- University Department of Surgery, General and Oncologic Hospital of Kifissia "Agii Anargiri", Athens, Greece; Anatomy and Histology Laboratory, Nursing School, University of Athens, Greece
| | | | - Konstantinos Birbas
- University Department of Surgery, General and Oncologic Hospital of Kifissia "Agii Anargiri", Athens, Greece
| | - Evangelos Konstantinou
- University Department of Surgery, General and Oncologic Hospital of Kifissia "Agii Anargiri", Athens, Greece
| | - Theodoros Mariolis-Sapsakos
- University Department of Surgery, General and Oncologic Hospital of Kifissia "Agii Anargiri", Athens, Greece; Anatomy and Histology Laboratory, Nursing School, University of Athens, Greece
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Ectopic liver and gallbladder in a cloned dog: Possible nonheritable anomaly. Theriogenology 2015; 84:995-1002. [PMID: 26159091 DOI: 10.1016/j.theriogenology.2015.05.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 05/28/2015] [Accepted: 05/28/2015] [Indexed: 01/21/2023]
Abstract
Ectopic liver and gallbladder are rare anomalies usually not accompanied by any symptoms and are found during surgical exploration or autopsy. We aimed to find a cause of this anomaly using somatic cell nuclear transfer (SCNT) technology, which can produce genetically identical organisms. A cloned beagle having ectopic organs was produced and died on the day of birth. Major and ectopic organs were fixed and underwent histologic analysis. SCNT was performed using cells derived from the dead puppy to produce reclones. Normality of internal organs in the original donor dog and recloned dogs was evaluated by computed tomography. While a liver without the gallbladder was located in the abdominal cavity of the cloned dog, a well-defined, reddish brown mass with a small sac was also positioned outside of the thoracic cavity. Histologically, they presented as normal liver and gallbladder. Five reclones were produced, and computed tomography results revealed that the original donor dog and reclones had normal liver and gallbladder structure and location. This is the first report of both ectopic liver and gallbladder in an organism and investigation on the etiology of these abnormalities. Normal organ structure and position in the original donor dog and reclones suggests that the ectopic liver and gallbladder is a possible nonheritable anomaly.
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Ishii H, Noguchi A, Onishi M, Takao K, Maruyama T, Taiyoh H, Araki Y, Shimizu T, Izumi H, Tani N, Yamaguchi M, Yamane T. True left-sided gallbladder with variations of bile duct and cholecystic vein. World J Gastroenterol 2015; 21:6754-6758. [PMID: 26074714 PMCID: PMC4458786 DOI: 10.3748/wjg.v21.i21.6754] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 01/06/2015] [Accepted: 02/12/2015] [Indexed: 02/06/2023] Open
Abstract
A left-sided gallbladder without a right-sided round ligament, which is called a true left-sided gallbladder, is extremely rare. A 71-year-old woman was referred to our hospital due to a gallbladder polyp. Computed tomography (CT) revealed not only a gallbladder polyp but also the gallbladder located to the left of the round ligament connected to the left umbilical portion. CT portography revealed that the main portal vein diverged into the right posterior portal vein and the common trunk of the left portal vein and right anterior portal vein. CT cholangiography revealed that the infraportal bile duct of segment 2 joined the common bile duct. Laparoscopic cholecystectomy was performed for a gallbladder polyp, and the intraoperative finding showed that the cholecystic veins joined the round ligament. A true left-sided gallbladder is closely associated with several anomalies; therefore, surgeons encountering a true left-sided gallbladder should be aware of the potential for these anomalies.
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Nastos C, Vezakis A, Papaconstantinou I, Theodosopoulos T, Koutoulidis V, Polymeneas G. Methods of safe laparoscopic cholecystectomy for left-sided (sinistroposition) gallbladder: A report of two cases and a review of safe techniques. Int J Surg Case Rep 2014; 5:769-73. [PMID: 25262322 PMCID: PMC4189091 DOI: 10.1016/j.ijscr.2014.08.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 08/15/2014] [Accepted: 08/19/2014] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Left-sided gallbladder is a rare anatomical variation. Usually it is discovered intra-operatively and is accompanied by anatomic variations that can prove quite challenging during laparoscopy. PRESENTATION OF CASE From a total of almost 3000 laparoscopic cholecystectomies performed in our institution, two cases of left sided gallbladder were unexpectantly identified intraoperatively. There were no indications for the ectopy preoperatively. In both cases modifications of the standard laparoscopic technique were mandatory. They were performed safely with no post-operative complications. Modifications consisted of transposition of the subxiphoid entry port and alteration in the direction of traction of the rest of the graspers. A review of the literature for methods of safe laparoscopic cholecystectomy was conducted. DISCUSSION The surgeon must be aware of the anatomic variances in the rare occasion of a left sided gallbladder, since preoperative diagnosis is very difficult. CONCLUSION Knowledge of potential hazards and modifications of laparoscopic technique is mandatory in order to avoid complications.
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Affiliation(s)
- Constantinos Nastos
- Second Department of Surgery, School of Medicine, University of Athens, Aretaieion University Hospital, 76 Vassilisis Sofia's Ave, 11528 Athens, Greece.
| | - Antonios Vezakis
- Second Department of Surgery, School of Medicine, University of Athens, Aretaieion University Hospital, 76 Vassilisis Sofia's Ave, 11528 Athens, Greece
| | - Ioannis Papaconstantinou
- First Department of Radiology, School of Medicine, University of Athens, Aretaieion University Hospital, Athens, Greece
| | - Theodosios Theodosopoulos
- Second Department of Surgery, School of Medicine, University of Athens, Aretaieion University Hospital, 76 Vassilisis Sofia's Ave, 11528 Athens, Greece
| | - Vassilios Koutoulidis
- Second Department of Surgery, School of Medicine, University of Athens, Aretaieion University Hospital, 76 Vassilisis Sofia's Ave, 11528 Athens, Greece
| | - George Polymeneas
- First Department of Radiology, School of Medicine, University of Athens, Aretaieion University Hospital, Athens, Greece
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Iskandar ME, Radzio A, Krikhely M, Leitman IM. Laparoscopic cholecystectomy for a left-sided gallbladder. World J Gastroenterol 2013; 19:5925-5928. [PMID: 24124340 PMCID: PMC3793148 DOI: 10.3748/wjg.v19.i35.5925] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 07/11/2013] [Accepted: 07/19/2013] [Indexed: 02/06/2023] Open
Abstract
Cholecystectomy is a common procedure. Abnormalities in the anatomy of the biliary system are common but an abnormal location of the gallbladder is much rarer. Despite frequent pre-operative imaging, the aberrant location of the gallbladder is commonly discovered at surgery. This article presents a case of a patient with the gallbladder located to the left of the falciform ligament in the absence of situs inversus totalis that presented with right upper quadrant pain. A laparoscopic cholecystectomy was performed and it was noted that the cystic duct originated from the right side. The presence of a left sided gall bladder is often associated with various biliary, portal venous and other anomalies that might lead to intra-operative injuries. The spectrum of unusual positions and anatomical gallbladder abnormalities is reviewed in order to facilitate elective and emergent cholecystectomy as well as other hepatobiliary procedures. With proper identification of the anatomy, minimally invasive approaches are still considered safe.
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