The Wandering Gallbladder: A Rare Case of Acute Cholecystitis in the Falciform Ligament

TL;DR

A rare case of a gallbladder attached to the falciform ligament is described, showing that laparoscopic surgery can be safely performed despite unusual anatomy.

Contribution

This case report highlights the successful laparoscopic management of an ectopic gallbladder in the falciform ligament, emphasizing diagnostic and surgical considerations.

Findings

The patient's gallbladder was found to arise from the falciform ligament during laparoscopic surgery.

Laparoscopic cholecystectomy was safely performed without bile duct injury or complications.

Maintaining awareness of rare anatomical variants is crucial to avoid surgical complications.

Abstract

Ectopic gallbladders are uncommon congenital variants that can complicate management of acute cholecystitis. They are rare, and their unusual positioning can pose diagnostic and intraoperative challenges. Because of their rarity, many ectopic gallbladders are not suspected until the time of surgery, increasing the potential risk of bile duct injury and prolonging operative time. Here, we present the case of a 41-year-old woman presenting with severe overnight epigastric pain following six months of intermittent pain. Examination revealed right upper quadrant and epigastric tenderness with a positive Murphy’s sign. Liver function tests were within normal limits, and imaging demonstrated cholelithiasis with mural edema and a positive sonographic Murphy’s sign. The patient underwent a laparoscopic cholecystectomy, where the patient’s gallbladder was found to arise from the falciform ligament, with further exploration showing no malrotation. The critical view of safety was achieved, the cystic artery and duct were clipped and divided, and the procedure was completed without hemorrhage or bile leak. The patient was discharged on postoperative day one. This case highlights the importance of maintaining awareness of rare anatomic variants to avoid bile duct injury and demonstrates that laparoscopic cholecystectomy remains a safe and effective approach in the presence of such anomalies.

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