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Case Reports
. 2019 Aug 15;12(8):e230681.
doi: 10.1136/bcr-2019-230681.

Surgical approach to a left-sided gallbladder

Ryan Pereira  1   2 , Marlon Perera  1 , Matthew Roberts  1 , John Avramovic  2
Affiliations
Case Reports

Surgical approach to a left-sided gallbladder

Ryan Pereira et al. BMJ Case Rep. .

Abstract

Biliary colic is a pain in the right upper quadrant or epigastrium thought to be caused by functional gallbladder spasm from a temporary obstructing stone in the gallbladder neck, cystic duct or common bile duct. A 56-year-old man presented with frequent episodes of typical biliary colic. At initial laparoscopy, the gallbladder was absent from its anatomic location. Further inspection revealed a left-sided gallbladder (LSGB), suspended from liver segment 3. Preoperative ultrasound, the most common imaging modality for symptomatic gallstones, has a low positive predictive value for detecting LSGB (2.7%). Laparoscopic cholecystectomy (LC) was delayed to attain additional imaging. A magnetic resonance cholangiopancreatography demonstrated the gallbladder left of the falciform ligament with the cystic duct entering the common hepatic duct from the left. The patient underwent an elective LC 8 weeks later. The critical view of safety is paramount to safe surgical dissection and could be safely achieved for LSGB.

Keywords: biliary intervention; general surgery; pancreas and biliary tract.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Left-sided gallbladder—suspended from liver segment 3 medially.
Figure 2
Figure 2
Transverse magnetic resonance cholangiopancreatography. Gallbladder left of round ligament. LSGB, left - sided gallbladder.
Figure 3
Figure 3
Modified laparoscopic port site placement. (1) Working port for fundus mobilisation, (2) working port for Hartmann’s pouch mobilisation, (3) camera port, (4) working port for electrocautery, (5) direct access initial camera entry and falciform lift.
Figure 4
Figure 4
After performing a falciform lift, the toothed grasper is used to retract gallbladder fundus towards the patient’s left shoulder.
See this image and copyright information in PMC

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Supplementary concepts