Wandering Gallbladder: A Case Report With Literature Review

Miroslav Kopp, DO1, Nathan Cornish2, Sharique Nazir, MD1. 1Lutheran Medical Center, 2New York Institute of Technology – College of Osteopathic Medicine

Introduction: Several variations in the anatomy of the biliary tree have been described in the literature. One such variation is a wandering gallbladder that is typically attached to surrounding structures only by the cystic duct and its mesentery. Its characteristic propensity for torsion places it at risk for necrosis and may present as an acute abdomen. There have been less than 10 reports of wandering gallbladder in the literature. The case of a 51-year-old male with right upper quadrant pain is presented. The possible clinical implications of this finding are discussed.

Case Report: A 51 year old male from Pakistan with a medical history significant for hypertension, GERD, high cholesterol, and renal stones presented to the Emergency Room with a chief complaint of right upper quadrant abdominal pain. Physical examination was remarkable for tenderness to palpation in the right upper quadrant. Abdominal ultrasound was significant for a mildly distended gallbladder with small gallstones in the gallbladder fundus, no gallbladder wall thickening or pericholecystic fluid, and no intrahepatic or extrahepatic biliary dilation. The patient had a history of biliary stones but had refused surgery in the past. The patient was discharged home with a diagnosis of cholelithiasis and scheduled for laparoscopic cholecystectomy as an outpatient. The patient was taken to the operating room for laparoscopic cholecystectomy. Upon entering the abdominal cavity a gallbladder was not seen in the gallbladder fossa. It was attached to the cystic duct, thickened with a long mesentery and not attached to the liver. There were no signs of torsion. The patient was treated successfully and discharged home with an uncomplicated hospital course.

Discussion: Free-floating or wandering gallbladder was first reported by Wendel in 1898. Since that time, over 500 cases of gallbladder torsion have been reported in the literature yet only approximately 10 cases of wandering gallbladder have been reported. Preoperative diagnosis is challenging because the clinical presentation can be variable with recurrent episodes of abdominal pain. The gallbladder is attached to the liver only by a mesentery and the cystic duct. This anatomic variant leads to hypermobility of the fundus and body of the gallbladder along its vertical axis. Torsion of the gallbladder occurs when it twists axially, with the subsequent occlusion of bile and/or blood supply. Early diagnosis of gallbladder torsion is important to avoid the complication of perforation and bilious peritonitis. The treatment for gallbladder torsion is a cholecystectomy. A literature review revealed limited reports on wandering gallbladder and to our knowledge no reports of cholecystectomy for wandering gallbladder found incidentally exist.

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Figure 1: Free floating GB in omentum

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Fugure 2: GB with retrograde dissection

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