Tolba Mohamed, Hafez Hadeer, Adel John
Faculty of medicine, Misr university for science and technology, Giza, Egypt.
Faculty of Medicine, October 6th University, Giza, Egypt.
Int J Emerg Med. 2025 Jan 3;18(1):5. doi: 10.1186/s12245-024-00785-0.
The coexistence of gallbladder (LSG) and adenomyomatosis (ADM) is extremely uncommon presenting a novel clinical dilemma that has not been previously documented. LSG refers to a anomaly where the gallbladder is situated to the left of the round ligament deviating from its usual position. This anomaly is rare, with reported occurrences ranging between 0.04% and 1.1%. Identifying LSG before surgery poses challenges. It is often discovered incidentally during procedures necessitating surgical expertise to safely manage anatomical variations.
We report an old man with a history of hepatitis C, carcinoma and liver cirrhosis complained of sudden epigastric pain. A CT scan revealed the presence of an LSG, which's a congenital anomaly. During the cholecystectomy procedure surgeons encountered variations and observed the existence of ADM complicating the operation. The patient recovered smoothly post surgery.
This case shows how complicated it can be to diagnose and treat the combination of LSG and ADM. Identifying these conditions before surgery is tough so surgeons often have to adjust their approach during the operation. Although laparoscopic cholecystectomy for LSG is usually safe it requires care to avoid problems like bile duct injuries. For patients at risk a conservative treatment approach might be better. In cases where surgery is necessary surgeons need to adapt their techniques to address the unique anatomical issues.
The combination of LSG and ADM in a setting poses an intricate challenge. Surgeons need to be ready to recognize and address these abnormalities effectively for the well being of the patient and favorable results. This particular case highlights the importance of staying alert and flexible during surgery when dealing with gallbladder variations.
胆囊左旋（LSG）与腺肌增生症（ADM）并存极为罕见，呈现出一种此前未被记录的新的临床困境。LSG指的是胆囊位于圆韧带左侧，偏离其正常位置的一种异常情况。这种异常很罕见，报道的发生率在0.04%至1.1%之间。在手术前识别LSG具有挑战性。它通常在需要外科专业知识来安全处理解剖变异的手术过程中偶然被发现。
我们报告一名有丙型肝炎、癌症和肝硬化病史的老年男性，主诉突发上腹部疼痛。CT扫描显示存在LSG，这是一种先天性异常。在胆囊切除术中，外科医生遇到了变异情况，并观察到存在ADM使手术复杂化。患者术后顺利康复。
该病例显示了诊断和治疗LSG与ADM合并症可能有多复杂。在手术前识别这些情况很困难，所以外科医生通常不得不术中调整手术方式。虽然针对LSG的腹腔镜胆囊切除术通常是安全的，但需要小心避免胆管损伤等问题。对于有风险的患者，保守治疗方法可能更好。在需要手术的情况下，外科医生需要调整技术以解决独特的解剖问题。
LSG和ADM在同一病例中的合并构成了一个复杂的挑战。外科医生需要随时准备好有效识别和处理这些异常情况，以保障患者健康并取得良好结果。这个特殊病例凸显了在手术中处理胆囊变异时保持警惕和灵活的重要性。
