Sinistropostion: A case report of true left-sided gallbladder in a Vietnamese patient

Tri Huu Nguyen, Tung Sanh Nguyen, Phu Doan Van Nguyen, Thanh Nhu Dang, Ernest Talarico

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)82-85
Number of pages4
JournalInternational Journal of Surgery Case Reports
Volume51
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

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Laparoscopic Cholecystectomy
Situs Inversus
Gallbladder
Anatomy
Round Ligaments
Portal System
Cystic Duct
Common Hepatic Duct
Incidental Findings
Viscera
Intraoperative Complications
Common Bile Duct
Biliary Tract
Cholecystectomy
Blood Vessels
Arteries
Liver
Wounds and Injuries
Left-sided gallbladder
Surgeons

Keywords

  • Case report
  • Gallbladder
  • Laparoscopic cholecystectomy
  • Left-sided gallbladder
  • Sinistroposition

ASJC Scopus subject areas

  • Surgery

Cite this

Sinistropostion : A case report of true left-sided gallbladder in a Vietnamese patient. / Nguyen, Tri Huu; Nguyen, Tung Sanh; Van Nguyen, Phu Doan; Dang, Thanh Nhu; Talarico, Ernest.

In: International Journal of Surgery Case Reports, Vol. 51, 01.01.2018, p. 82-85.

Research output: Contribution to journalArticle

Nguyen, Tri Huu ; Nguyen, Tung Sanh ; Van Nguyen, Phu Doan ; Dang, Thanh Nhu ; Talarico, Ernest. / Sinistropostion : A case report of true left-sided gallbladder in a Vietnamese patient. In: International Journal of Surgery Case Reports. 2018 ; Vol. 51. pp. 82-85.
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abstract = "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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