PMC5684543_01
Transabdominal ultrasound demonstrated sludge and stones in a contracted gallbladder.
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Abdominal ultrasound demonstrated cholelithiasis and sludge in an intrahepatic gallbladder located in her ectopic liver, but no evidence of gallbladder wall thickening or pericholecystic fluid (Figure 1).
Coronal and sagittal computed tomography pictures showing the pelvic location of the liver and the intrahepatic location of the gallbladder.
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Previous computed tomography (CT) scans demonstrated an ectopic liver located in the pelvis as well as an intrahepatic gallbladder and interval contracture of the gallbladder in subsequent scans (Figures 2 and 3).
Axial computed tomography pictures showing contracture of the gallbladder from 2009 to 2012.
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Previous computed tomography (CT) scans demonstrated an ectopic liver located in the pelvis as well as an intrahepatic gallbladder and interval contracture of the gallbladder in subsequent scans (Figures 2 and 3).
MRCP shown in (a) and intraoperative cholangiogram in (b) depicting the biliary tree with the gallbladder inferiorly. The hepatic ducts join to form the common hepatic and bile ducts (red arrow) that empty into the duodenum which has its usual right upper quadrant location. The pancreatic duct is depicted by the blue arrow. D = duodenum.
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Magnetic resonance cholangiopancreatography (MRCP) demonstrated a relatively decompressed intrahepatic gallbladder in the pelvis joining the hepatic duct more superiorly with the common bile duct emptying into the duodenum, which has its usual right upper quadrant location (Figure 4). The right and left hepatic ducts were visualized, as well as a long common bile duct, which traveled cranially to the right upper quadrant, where contrast was visualized within the duodenum (Figure 4).
Midline laparotomy incision demonstrating the ectopic liver with adhesions (a, b). Hepatotomy exposing the intrahepatic gallbladder inferior to forceps (c) and dissected free of the surrounding parenchyma and retracted left laterally (d).
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The cleft was extended to the edge of the liver and down to the gallbladder with a recently introduced microwave ablation technology for hepatic parenchymal pretransection coagulation, to expose the gallbladder, which was then separated from the surrounding liver parenchyma (Figure 5).