Magdaleno GM, Flores VER, Rivera GFJ, Ortega PH, Meléndez DMD

Language: Spanish
References: 8
Page: 54-57
PDF size: 208.16 Kb.

ABSTRACT

Introduction: Left-sided gallbladder without situs inversus (sinistropositio) is a rare variant, with a frequency of 0.1% to 1.2%. Case report: This is a 31-year-old female with a history of a cesarean surgery seven months earlier in her first pregnancy and a three-month biliary colic. No abnormal laboratory test results were detected. Ultrasound: a gallbladder in a normal position, 8 × 7 cm in size, with small gallstones; no bile duct dilation. She was programmed for elective ambulatory laparoscopic cholecystectomy. Technique: under general anesthesia, insufflation with a Veress needle and placement of 10 mm umbilical and subxiphoid trocars were performed; the patient was positioned in the American position. Through laparoscopy, the gallbladder was located on the left side of the teres ligament; therefore, it was decided to place subcostal bilateral 5 mm trocars over the clavicular midlines in a French position. Then, adhesiolysis was performed, as well as a dissection of the Calot triangle with extended critical vision. A cystic catheter cholangiography was done without complications, clips were placed proximal, two on the cystic duct and the artery; then, we proceeded with complete dissection and gallbladder extraction, continued with gas aspiration, intraperitoneal local anesthesia, closure by layers and drainage placement. Oral intake took place within two hours post-op, and she was discharged from the hospital after 3.5 hours. She appeared normal in the 12-week follow-up. Histopathologic report: chronic gallstone cholecystitis. Conclusions: Anatomic variants should be considered and a thorough abdominal inspection should be performed prior to the placement of the trocars. Left-sided gallbladder is regularly a surgical finding and usually it is not diagnosed by ultrasound.

REFERENCES

1. Idu M, Jakimowicz J, Iuppa A, Cuschieri A. Hepatobiliary anatomy in patients with transposition of the gallbladder: implications for safe laparoscopic cholecystectomy. Br J Surg. 1996; 83: 1442-1443.

2. Nagai M, Kubota K, Kawasaki S, Takayama T, Bandai Y, Makuuchi M. Are left-side gallbladders really located on the left side? Ann Surg. 1997; 225: 274-280.

3. Maetani Y, Itoh K, Kojima N, Tabuchi T, Shibata T, Asonuma K et al. Portal vein anomaly associated with deviation of the ligamentum teres to the right and malposition of the gallbladder. Radiology. 1998; 207: 723-728.

4. Donthi R, Thomas DJ, Sanders D, Schmidt SP. Report of laparoscopic cholecystectomy in two patients with left side gallbladders. JSLS. 2001; 5: 53-56.

5. Reddy PK, Subramanian RV, Yuvaraja S. Laparoscopic cholecystectomy for left side gallbladder (sinistroposition). JSLS. 2005; 9: 356-357.

6. Hsu SL, Chen TY, Huang TL, Sun CK, Concejero AM, Tsang LL et al. Left-sided gallbladder: its clinical significance and imaging presentations. World J Gastroenterol. 2007; 13: 6404-6409.

7. Iskandar ME, Radzio A, Krikhely M, Leitman IM. Laparoscopic cholecistectomy for a left-sided gallbladder. World J Gastrointestinal. 2013; 19: 5925-5928.

8. Leone V, Console N. Management of incidental left-sided gallbladder in laparoscopic cholecistectomy. Journal of Current Surgery. 2013; 3: 41-43.