Left sided gallbladder: a rare case report and approaches to surgical management

Left-sided gallbladder (LSGB) is a rare anatomical anomaly defined by its location to the left of the round ligament. With a reported incidence of 0.7-1.2%, LSGB is clinically significant due to association with the biliary tree and vascular abnormalities, which can increase technical difficulty and risk of intra-operative injury during laparoscopic cholecystectomy. We describe the case of a female patient in her 30s who presented with sudden onset epigastric pain in the context of recurrent gallstone pancreatitis. Pre-operative imaging, including ultrasound, CT and MRCP showed non-obstructive cholelithiasis with no obvious anatomical abnormalities. A gallbladder located to the left of the falciform ligament, in keeping with a true LSGB, was identified during her laparoscopic cholecystectomy. To obtain optimal retraction and exposure, an additional left upper quadrant port was inserted. Intra-operative cholangiogram demonstrated conventional biliary anatomy with the cystic duct draining to the right of the hepatic duct. The patient had an uncomplicated post-operative recovery. LSGB is often diagnosed intra-operatively and carries an increased risk of biliary and vascular injury. Early recognition and modification of surgical technique, including adjustment of port placement and use of intra-operative cholangiography may be helpful to achieve critical view of safety and minimise operative complications.