Cholecystectomy of an Intrahepatic Gallbladder in an Ectopic Pelvic Liver: A Case Report and Review of the Literature

Abstract

Introduction: Ectopic pelvic liver is an exceedingly rare condition usually resulting after repair of congenital abdominal wall defects. Intrahepatic gallbladder is another rare condition predisposing patients to cholelithiasis and its sequelae. We describe a cholecystectomy in a patient with an intrahepatic gallbladder in a pelvic ectopic liver.

Presentation of case: A 33-year-old woman with a history of omphalocele repair as an infant presented with signs and symptoms of symptomatic cholelithiasis and chronic cholecystitis, however, in an unusual location. After extensive workup and symptomatic treatment, cholecystectomy was recommended and performed via laparotomy and hepatotomy using microwave technology for parenchymal hepatic transection.

Discussion: Given the rare combination of an intrahepatic gallbladder and an ectopic pelvic liver, advanced surgical techniques must be employed for cholecystectomies, in addition to involvement of hepatobiliary experienced surgeons due to the distortion of the biliary and hepatic vascular anatomy.

Conclusion: Cholecystectomy by experienced hepatobiliary surgeons is a safe and effective treatment for cholecystitis in patients with intrahepatic gallbladders in ectopic pelvic livers.

Figure 1

Transabdominal ultrasound demonstrated sludge and stones in a contracted gallbladder.

Figure 2

Coronal and sagittal computed tomography pictures showing the pelvic location of the liver and the intrahepatic location of the gallbladder.

Figure 3

Axial computed tomography pictures showing contracture of the gallbladder from 2009 to 2012.

Figure 4

MRCP shown in (a) and intraoperative cholangiogram in (b) depicting the biliary tree with the gallbladder inferiorly. The hepatic ducts join to form the common hepatic and bile ducts (red arrow) that empty into the duodenum which has its usual right upper quadrant location. The pancreatic duct is depicted by the blue arrow. D = duodenum.

Figure 5

Midline laparotomy incision demonstrating the ectopic liver with adhesions (a, b). Hepatotomy exposing the intrahepatic gallbladder inferior to forceps (c) and dissected free of the surrounding parenchyma and retracted left laterally (d).