Incidental left-sided gallbladder without situs inversus discovered during laparoscopic cholecystectomy: a rare case report

Introduction and importance: Left-sided gallbladder (LSG) without situs inversus is a rare anatomical variant, which is recognized by the gallbladder being located left to the falciform ligament. It is often detected incidentally during surgery. Failure to recognize this variant may increase the risk of bile duct injury. Case presentation: This is the case report of a 42-year-old woman who presented with swelling around the umbilical region for 6 months. Ultrasonography of the abdomen and pelvis showed an umbilical hernia with cholelithiasis but failed to detect the left-sided position of the gallbladder. She was then planned for elective laparoscopic cholecystectomy with primary repair of the umbilical hernia. Intraoperatively, the gallbladder was found left to the falciform ligament. Intraoperative cholangiography was not done. Laparoscopic cholecystectomy was completed using the standard four-port technique without additional port placement. Primary repair of the umbilical hernia was also done in the same operative setting. The postoperative course was uneventful, and the patient was discharged on postoperative day 2. Patient remained asymptomatic without any complications on follow-up at 2 and 4 weeks postoperatively. Discussion: LSG is uncommon and may not be detected on preoperative imaging but when discovered incidentally during laparoscopic cholecystectomy, it can be managed safely with or without any modifications. This case highlights safe completion of surgery without additional port placement after clear identification of biliary anatomy with simultaneous umbilical hernia repair. Conclusion: Surgeons should be aware of LSG as a potential anatomical variation and adopt cautious dissection strategies that may require modifications of laparoscopic techniques to prevent iatrogenic injury to surrounding structures.