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

• Published in: International journal of surgery case reports 2018-01, Vol.51, p.82-85
• Main Authors: Nguyen, Tri Huu, Nguyen, Tung Sanh, Van Nguyen, Phu Doan, Dang, Thanh Nhu, Talarico, Ernest F.
• Format: Article
• Language: English
• Subjects: Case report; Gallbladder; Laparoscopic cholecystectomy; Left-sided gallbladder; Sinistroposition
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2018.08.018

•Left-sided gallbladder without situs viscerum inversus is a rare congenital anomaly.•Left-sided gallbladder is accompanied by anatomic variations: portal vein and/or biliary system anomalies, segment IV atrophy, variations in hepato-biliary vascular anatomy.•Left-sided gallbladder can present significant intraoperative challenges due to associated variations in ductal and vessel anatomy.•There are three proposed, embryologic mechanisms for Left-sided gallbladder without situs viscerum inversus.•Even the face of routine preoperative testing, ultrasound, and CT scan, left-sided gallbladder often remains undetected until surgery.•Laparoscopic antegrade cholecystectomy can be performed safely for left-sided gallbladder. 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. 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. 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. 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.