Cholecystitis Associated With a Suprahepatic Gallbladder: Surgical Challenges and Technical Considerations

Suprahepatic gallbladder is a rare anatomical variant in which the gallbladder body and fundus are displaced superiorly along the common hepatic duct, often associated with hypoplasia of the medial segment of the left hepatic lobe. Surgical treatment of cholecystitis in such cases presents significant technical challenges due to the aberrant position of the gallbladder and its proximity to the major bile ducts. The management of two cases of cholecystitis associated with suprahepatic gallbladder is reported. Case 1 was an 87-year-old woman with cholecystitis and choledocholithiasis. Magnetic resonance cholangiopancreatography (MRCP) identified a suprahepatic gallbladder. Mild dilation of the common bile duct (CBD) was noted, with the presence of endoluminal biliary sludge. In this case, an endoscopic retrograde gallbladder drainage (ERGBD) stent was placed in the cystic duct and an endoscopic retrograde biliary drainage (ERBD) stent was placed in the CBD. Case 2 was an 85-year-old male with a history of liver cirrhosis and esophageal varices who visited a clinic with gallstone impaction. Imaging revealed Chilaiditi syndrome, featuring a suprahepatic gallbladder positioned anterior to the liver. The fundus of the gallbladder extended superiorly to the level of the diaphragm. Laparoscopic cholecystectomy was completed without bile duct injury or bile duct leakage, but the patient later developed portal and mesenteric venous thrombosis on postoperative day 10, leading to fatal multi-organ failure. In the management of cholecystitis of suprahepatic gallbladder, we successfully carried out different approaches; one was by ERGBD and the other by laparoscopic cholecystectomy without CBD injury.