PMC5048624_01
Abdominal Computed Tomography (CT): (a): Gallbladder, (b): Liver, (c): Spleen.
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CT was 'acceptable' in light of the situs inversus totalis [Fig. 1]. CBC, blood chemistries, and liver function tests were all within normal limits.
(a): Gallbladder, (b): Stomach, (c): Spleen, (d): previous Nissen fundoplication, (e): Cecum, (f): Liver.
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Exploring the abdomen, the gallbladder was distended with omental adhesions in addition to light adhesions at the previous surgical site [Fig. 2D].
(a): Calot's Node, (b): Cystic Duct, (c): Main Cystic Artery, (d): Additional Cystic Artery, (e): Additional Cystic Artery (clipped and cut).
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The cystic duct inferiorly and the main cystic artery in Calot's triangle were identified [Fig. 3B,C], the duct was endo-clipped and cut in the standard fashion. Here beside the main cystic artery, a thin accessory artery extending along the cystic duct but posterior to it was recognized [Fig. 3.D].