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Chirurgia 2017 June;30(3):107-11

DOI: 10.23736/S0394-9508.16.04634-9


language: English

Unusual anatomical variations finding in a case of acute pancreatitis: ectopic gallbladder inserted into accessory hepatic lobe

Mircea MUREȘAN 1, Simona MUREȘAN 2, Hussam AL HUSSEIM 3, Klara BRÎNZANIUC 4, Radu NEAGOE 1

1 Clinical Surgery No.2, University of Medicine and Pharmacy of TîrguMures, TîrguMures, Romania; 2 Department of Physiology, University of Medicine and Pharmacy of TîrguMures, TîrguMures, Romania; 3 University of Medicine and Pharmacy of TîrguMures, TîrguMures, Romania; 4 Department of Anatomy, University of Medicine and Pharmacy of TîrguMures, TîrguMures, Romania


The gallbladder anatomic abnormalities and its variants are extremely rare and are usually, detected intraoperativelly as a result of complications. We present the case of the patient NB, aged 44 years, presented to surgery department for epigastric pain, nausea, vomiting. In laboratory, we find leukocytosis, hiperamylasemia and a moderate hepatocytolisis. The ultrasound reveals an acute pancreatitis aspect and apparent intrahepatic gallbladder located in the epigastric region, with multiple images of stones inside and thickened walls. Due to the unfavorable evolution to abdominal compartment syndrome developing, we undergone median laparotomy and found a gallbladder located ectopic, in the epigastric region, inserted on a pedicled accessory hepatic lobe, with the insertion point on the anterior edge of the segment IV, right next to the round ligament. We practiced an anterograde cholecystectomy, the cystic duct having a vertical trajectory through the hepatic fissure to the anterior flank of the common hepatic duct. Due to the possibility of further twist, the accessory hepatic lobe is also resected. The postoperative evolution is favorable, patient being discharged in the 10th postoperative day. The anatomical variants of the gallbladder have a paramount importance in the surgical practice, significantly reducing the morbidity by ductal lesions or intraoperative bleeding.

KEY WORDS: Gallbladder - Embryology - Abnormalities

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