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 Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 3  |  Issue : 3  |  Page : 175-177

Transverse gallbladder: A case report


1 Demonstrator, Department of Anatomy, Gauhati Medical College, Guwahati, Assam, India
2 Professor and Head, Department of Anatomy, Tezpur Medical College, Tezpur, Assam, India
3 Associate Professor, Department of Anatomy, Assam Medical College, Dibrugarh, Assam, India

Date of Web Publication21-Jan-2020

Correspondence Address:
Shobhana Medhi
C/O. Prof. Lakshi Kanta Medhi, House No. 27, Kekora Nagar, Hengrabari, P.O. Assam Secretariat, Guwahati - 781006, Assam
India
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Source of Support: None, Conflict of Interest: None


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  Abstract 


Ectopic gallbladder or anomalous position of the gallbladder is a rare congenital anomaly. Knowledge and awareness of this anomaly is important as it may predispose to various gallbladder diseases and may lead to diagnostic confusion. Here we present a case of a rare variant of ectopic gallbladder - transverse or horizontal position of the gallbladder in a still born male fetus observed during routine fetal autopsy.

Keywords: Ectopic gallbladder, Anomalous position


How to cite this article:
Medhi S, Baruah A, Kusre G. Transverse gallbladder: A case report. Natl J Clin Anat 2014;3:175-7

How to cite this URL:
Medhi S, Baruah A, Kusre G. Transverse gallbladder: A case report. Natl J Clin Anat [serial online] 2014 [cited 2022 Jan 23];3:175-7. Available from: http://www.njca.info/text.asp?2014/3/3/175/297379




  Introduction Top


The human gallbladder is reported to present with a wide range of anatomical variations pertaining to its size, shape, number and position[1]. They have been reported to occur in 0.1 % of the population[2]. Abnormal gallbladders may predispose to bile stasis, inflammation and formation of gall stones[3]. Ectopic gallbladder or anomalous position of the gallbladder seems to be one of the rare congenital anomalies of the gallbladder, its incidence being 0.1-0.7%[1],[4],[5]. Gallbladder disease in an anomalous or a malpositioned gallbladder may cause diagnostic confusion[3]. Of the different types of ectopic positions of the gallbladder, transverse or horizontal position seems to be of a rare variety with reports of only a few sporadic cases in the existing literature. We present here such a rare case of a transversely placed gallbladder observed during routine fetal autopsy.


  Case Report Top


A stillborn male fetus was dissected during routine fetal autopsy as a part of Congenital Malformation Survey in Assam Medical College, after taking the informed consent of the parents of the baby. Ethical clearance for undertaking the study was taken from the Institutional Ethical Committee. On examination of the organs of the fetus in situ, it was observed that the fundus of the gallbladder could not be localized along the inferior border of the liver. In an attempt to visualize the gallbladder, the liver was dissected out by severing its attachments with the anterior abdominal wall and the undersurface of the diaphragm. The liver along with the extra-hepatic biliary tree, the duodenum and the pancreas were dissected out en-mass and examined. It was seen that the gallbladder was transversely placed, extending laterally from the right end of the porta hepatis, along the inferior surface of the right lobe of the liver [Figure 1][Figure 2]. The usual gallbladder fossa and the cystic notch were obliterated. Rest of the extra- hepatic biliary tree was normal. The other systems of the fetus were also found to be normal.
Figure 1: The Transverse Gallbladder

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Figure 2: Schematic representation of the transverse gallbladder. The dotted line outlines the usual position of the gallbladder
(Abbreviations: GB - Gallbladder, JVC -Inferior Vena Cava.)


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  Discussion Top


The gallbladder is a pear-shaped sac lodged in a fossa on the visceral surface of the liver, between the quadrate lobe and the right lobe of the liver. It extends from near the right end of the porta-hepatis to the inferior border of the liver. Its anterior or upper surface is attached to the fossa by connective tissue, while its posterior or undersurface and sides are covered with peritoneum continued from the surface of the liver. The blind expanded end of the gallbladder, known as the “Fundus of the Gallbladder” is directed downwards, forwards and to the right and normally projects beyond the inferior border of the liver[6],[7]. Any position other than this can be said to be anomalous or ectopic position of the gallbladder. There are four types of Ectopic gallbladders: (i) Intrahepatic, (ii) Left-sided, (iii) Transverse, and (iv) Retrodisplaced[8]. Ectopic gallbladders have also been reported in the lesser omentum, the retroduodenal area, the falciform ligament, within the abdominal wall muscles, and within the thorax[9].

The normal gallbladder configuration is reached after a unique developmental process. Embryologically it begins as a small hollow bud which arises from the duodenum and grows upwards into the septum transversum. This bud then divides into two, of which one forms the gallbladder and cystic duct, and the other gives rise to the main mass of the glandular substance of the liver. Therefore any arrest or deviation from this developmental process or abnormal migration of the bud may result in ectopic or anomalous position of the gallbladder[3],[10].

Anomalous position of the gallbladder seems to be a rare congenital anomaly. Out of40,000 upper abdominal ultrasound examinations, only four cases of anomalous positions of the gallbladder were noted[11]. Again, among the different varieties of anomalous positions described by different workers like Blanton et al[4], Chuang[8] and Haaga et al[12], transverse or horizontal position seems to be a rare variant with reports of only a few sporadic cases. Gay[13] and Chuang[8] were among those who reported about such cases. However, though rare, these ectopic gallbladders when present may predispose to a wide range of gallbladder diseases, which can turn dangerous, as it can cause diagnostic confusion[3]. Besides, such anomalies of the gallbladder can even result in misinterpretation of imaging findings[9]. Therefore, awareness of the possibility of encountering such an entity is an essence during any diagnostic or surgical intervention in this region.


  Conclusion Top


Transverse position of the gallbladder, though reported very rarely, its existence must be kept in mind during any intervention involving the gallbladder in order to avoid any diagnostic confusion.

Acknowledgements

We sincerely acknowledge the support of Mrs. Puspanjali Tairai, MSc (Biotech), Research Assistant, in carrying out the routine autopsies in the Department of Anatomy, Assam Medical College, Dibrugarh, Assam, India. We also sincerely thank ICMR New Delhi, India, for providing the financial support for the survey.



 
  References Top

1.
Gross RE. Congenital Anomalies of the Gallbladder: A Review of One Hundred and forty-eight cases, with report of a double gallbladder. Arch Surg. 1936; 32 (1): 131-162.  Back to cited text no. 1
    
2.
Johnson SR. Development of the liver and biliary apparatus. In: Romanes GJ (Ed.). Cunninghams Textbook of Anatomy. 12th ed. Oxford, Oxford University Press, 1987:481 - 485.  Back to cited text no. 2
    
3.
Feldman M, Friedman L S and Sleisenger MH (Ed.). Feldman. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease, Pathology/ Diagnosis/ Management, 9th ed, Vol 1, Publishers Saunders, Philadelphia, London, New York, St Louis, Sydney, and Toronto ,2010:1050.  Back to cited text no. 3
    
4.
Blanton DE, Bream CA, Mandel SR. Gallbladder Ectopia: A review of anomalies of position. Am J Roentgenol. 1974; 121:396.  Back to cited text no. 4
    
5.
Meilstrup JW, Hopper KD, Hieme GA. Imaging of gall bladder variants. Am J Roentgenol. 1991; 152:1205-1208.  Back to cited text no. 5
    
6.
Johnston TB, Davies DV, Davies F (Ed.). The Digestive System- The Liver-the excretory apparatus. Gray’s Anatomy- Descriptive & Applied. 32nd ed. Longman, Green & Co., London- New York-Toronto, 1958:1465 - 1469.  Back to cited text no. 6
    
7.
Hollinshead WH (Ed.). Chapter 20: The Abdomen. Textbook of Anatomy. 2nd ed. Oxford & IBH Publishing Co. Calcutta. Bombay. New Delhi, 1967, 561-678.  Back to cited text no. 7
    
8.
Chuang VP. The Aberrant Gall Bladder: Angiographic and Radioisotopic Considerations. AJR Am J Roentgenol, 1976; 127(3): 417-421.  Back to cited text no. 8
    
9.
Manju BP, Popli V and Solanki Y. Ectopic Gall Bladder: A Rare Case. Saudi J Gastroenterol. 2010; 16(1): 50.  Back to cited text no. 9
    
10.
Rabinovitch J, Rabinovitch P, Rosenblat P, Pines B. Congenital Anomalies of the Gallbladder. Ann Surg. 1958; 148(2): 161-168.  Back to cited text no. 10
    
11.
Pradip VM, Ramachandran K, Sasidharan K. Anomalous Position of the Gallbladder: Ultrasonographic and Scintigraphic Demonstration in Four Cases. J Clin Ultrasound. 1992; 20 (9): 593-597.  Back to cited text no. 11
    
12.
Haaga JR, Herbener TE (Ed.). The gall bladder and biliary tract: CT and MR of Imaging of the whole body; 4th ed. Missouri: Mosby, Inc; 2003:1341-94.  Back to cited text no. 12
    
13.
Gay RJ. Developmental Anomalies of the Gallbladder with Report of a Case. J Chicago Path Soc. 1902;5:108.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2]



 

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