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Image capture from robotic cholecystectomy. a Suprahepatic gallbladder ( asterisk sign ) prior to resection. Cirrhotic appearance of liver can also be appreciated. b Suprahepatic gallbladder ( asterisk sign ) has been dissected from the liver using a dome-down approach. Cystic artery ( black arrow ) has been ligated and transected. Cystic duct infun- dibular junction ( number sign ) is visualized here
Source publication
Suprahepatic gallbladders have been reported in the literature dating back to 1965. However, their etiology and consequences remain unclear.
A case of a patient being treated for biliary dyskinesia with an incidental finding of suprahepatic gallbladder is presented along with a literature review on the causes, effects, and management of a suprahepa...
Context in source publication
Context 1
... to have biliary dyskinesia, and a laparoscopic cholecystectomy was planned. Upon placement of the camera cirrhosis, hepatomegaly, and ascites were noted. The surgery was aborted, and the patient was transferred to a tertiary care center for further management. Upon review of imaging stud- ies with radiology, a suprahepatic gallbladder was found (Fig. ...
Citations
... Unusual biliary symptoms require keen observation, where misinterpretation of imaging is crucial [11]. The first case of an ectopic gallbladder was reported by Bergmanin in 1702, with several cases reported later [12]. ...
An ectopically located gallbladder is a rare entity. Here, we present a case of an ectopic gallbladder with left hepatic lobe agenesis. In this study, we describe the case of a 56-year-old male who was a known diabetic patient. He presented with abdominal pain, which started two weeks prior. Computed tomography (CT) abdomen with contrast was advised by the primary team, which showed an incidental ectopic gallbladder along the right posterior-inferior margins of the liver. Associated with it, there was complete agenesis of the left hepatic lobe, including absent segments II, III, and IV. Most of the commonly encountered ectopic positions include intrahepatic, transverse, retrohepatic, retroperitoneal, suprahepatic, falciform ligament, or under the left liver lobe. Ectopic gallbladders have clinical significance as they alter the clinical presentation of cholecystitis. They create technical challenges during cholecystectomy and other biliary operations and cause misdiagnosis in imaging. A thorough inspection of the biliary tract in patients undergoing surgery is suggested before electrocoagulation. A radiologist must always inform the clinician about the existence of an aberrant gallbladder.
... On the other hand, suprahepatic gallbladder is the most infrequent location of gallbladder ectopies (0.026-0.7%). It is associated with an abnormal development of the right liver lobe such as agenesis, hypoplasia or atrophy (4). ...
Chilaiditi's sign is the interposition of small bowel or colon between the liver and diaphragm. This incidental finding is seen in 0,025-0,28% of the chest and abdominal radiographies. Predisposing factors include the absence, laxity or elongation of the suspensory ligaments of the transverse colon, redundant colon or elevation of the right hemidiaphragm. Atrophy or hypoplasia of the liver is an uncommon cause of this radiological sign. On the other hand, suprahepatic gallbladder is the most infrequent location of gallbladder ectopies (0,026-0,7%). It is associated with an abnormal development of the right liver lobe such as agenesis, hypoplasia or atrophy. We present the case of a 73-year-old man with Chilaiditi's sign, hepatic hypoplasia and acute calculous cholecystitis in an ectopic suprahepatic gallbladder.
... The anatomy of the extrahepatic biliary structures including the gallbladder shows high variability. Variations and anomalies of the gallbladder include folding of the gallbladder fundus called phyrygian cap, that occurs in 1% to 6% of the subjects (160), duplication (26), bilobed gallbladder (179), diverticulum (193), hypoplasia or agenesis (16), and ectopic location (87). Agenesis of the gallbladder occurs in 0.035% to 0.3% of the subjects and can be isolated or associated with other congenital malformations (16). ...
The gallbladder stores and concentrates bile between meals. Gallbladder motor function is regulated by bile acids via the membrane bile acid receptor, TGR5, and by neurohormonal signals linked to digestion, for example, cholecystokinin and FGF15/19 intestinal hormones, which trigger gallbladder emptying and refilling, respectively. The cycle of gallbladder filling and emptying controls the flow of bile into the intestine and thereby the enterohepatic circulation of bile acids. The gallbladder also largely contributes to the regulation of bile composition by unique absorptive and secretory capacities. The gallbladder epithelium secretes bicarbonate and mucins, which both provide cytoprotection against bile acids. The reversal of fluid transport from absorption to secretion occurs together with bicarbonate secretion after feeding, predominantly in response to an adenosine 3',5'-cyclic monophosphate (cAMP)-dependent pathway triggered by neurohormonal factors, such as vasoactive intestinal peptide. Mucin secretion in the gallbladder is stimulated predominantly by calcium-dependent pathways that are activated by ATP present in bile, and bile acids. The gallbladder epithelium has the capacity to absorb cholesterol and provides a cholecystohepatic shunt pathway for bile acids. Changes in gallbladder motor function not only can contribute to gallstone disease, but also subserve protective functions in multiple pathological settings through the sequestration of bile acids and changes in the bile acid composition. Cholecystectomy increases the enterohepatic recirculation rates of bile acids leading to metabolic effects and an increased risk of nonalcoholic fatty liver disease, cirrhosis, and small-intestine carcinoid, independently of cholelithiasis. Among subjects with gallstones, cholecystectomy remains a priority in those at risk of gallbladder cancer, while others could benefit from gallbladder-preserving strategies. (C) 2016 American Physiological Society.
Ultrasound is the ideal imaging technique for evaluation of the gallbladder and biliary tree given its excellent spatial resolution and inherently high contrast between the fluid-filled gallbladder and bile ducts compared to the adjacent soft tissues. Ultrasound evaluation is performed for the investigation of congenital anomalies, cholelithiasis, biliary tract obstruction, and tumors. An overview of normal development and anatomy of the gallbladder and biliary tree is provided, and the ultrasound imaging findings of a broad spectrum of abnormalities are discussed, along with pertinent clinical features of each entity and treatment approach.
Suprahepatic gall bladder is rare, and torsion of the ectopic gall bladder is extremely rare. We report a patient of acute suprahepatic cholecystitis with torsion. A 69-year-old Korean male was admitted to our hospital for sudden-onset, severe epigastric pain. Abdominal computed tomography and ultrasonography showed a distended gall bladder with diffuse wall thickening and scanty pericholecystic fluid, which was located in ectopic suprahepatic position, accompanied by S4 hypotrophy of the liver without gallstones. Emergency laparoscopic cholecystectomy was performed, and intraoperative findings revealed a distended and ischaemic gall bladder that was located in the suprahepatic position and had twisted along the cystic duct and artery pedicle in a clockwise manner. Detorsion was done and the gall bladder was resected. Unfortunately, the pre-operative diagnosis of gall bladder torsion was missed, and a definite diagnosis was made at the time of surgery. The patient was discharged on the 4th post-operative day.
The gallbladder is generally located at the anterolaterally situated gallbladder fossa on the undersurface of the liver, whereas choledochal cyst, as a dilation of the common bile duct, is located more posteromedially. We reported an ectopically located gallbladder, which appeared to be a choledochal cyst on hepatobiliary scintigraphy in a 10-year-old girl.
