True Left-Sided Gallbladder: A Case Report of Rare Incidental Findings During Cholecystectomy in a Jordanian Patient

The biliary system exhibits significant anatomical variations, which pose challenges for most surgeons during cholecystectomy. Among these variations, a true left-sided gallbladder (LSG) is an uncommon finding. In such cases, the gallbladder is located to the left of the round ligament. Although it can be diagnosed by preoperative imaging, such as magnetic resonance imaging and computed tomography, true LSG is diagnosed intraoperatively in most reported cases. A 33-year-old man with no medical or surgical history presented with recurrent attacks of typical biliary colic and was admitted for elective laparoscopic cholecystectomy after abdominal ultrasonography showed a single large gallbladder stone that measured 3.3 cm. No further imaging studies were performed because the patient's presentation, physical examination, and laboratory results did not indicate any biliary tree obstruction or suspicious biliary anomaly. Intraoperatively, the gallbladder was not found in its normal anatomical position, and the diagnosis of true LSG was confirmed when the gallbladder was detected to the left of the round ligament. The surgery was completed safely using a standard laparoscopic approach. The patient was discharged home on the second postoperative day. True LSG is the most common variant of LSG without situs viscerum inversus (woSVI). The presentation of true LSG is similar to that of a normally positioned right-sided gallbladder. In most cases, it is discovered during surgery and may necessitate modifications to the surgical approach, such as adding laparoscopic ports, changing the standard position of the ports, changing the patient's or surgeon's position, or converting to an open technique. Incidental findings of true LSG during cholecystectomy should not preclude a laparoscopic approach. It requires meticulous dissection and advanced surgical skills to perform a safe cholecystectomy and avoid inadvertent biliary injury. Although modifications to the laparoscopic technique will help in the safe removal of the gallbladder, a standard laparoscopic approach is still feasible in most cases. Conversion to open surgery may be considered if the biliary anatomy cannot be clearly identified.