Rare Sigmoid Gallbladder Case Highlights Importance of Preoperative Imaging in Gallstone Surgery
Ethiopia: Researchers have reported a rare case of a sigmoid gallbladder in a 38-year-old woman with gallstone disease. The case, published in BMC Surgery by Abduletif Haji-Ababor Abagojam, General Surgeon at Jimma University, Ethiopia, and colleagues, highlights how unusual gallbladder anatomy can complicate diagnosis and surgical procedures, emphasizing the importance of detailed imaging and surgical precision in managing such anomalies.
The sigmoid gallbladder is an extremely uncommon anatomical variation in which the organ takes on an S-shaped configuration due to abnormal embryonic development. Although often asymptomatic, this anomaly can pose serious challenges during gallbladder removal (cholecystectomy) by obscuring the cystic duct and artery, thus increasing the risk of bile duct injury. Preoperative imaging, especially magnetic resonance cholangiopancreatography (MRCP), plays a vital role in identifying such variations before surgery.
In this case, a 38-year-old Ethiopian woman presented with a six-month history of recurrent right upper abdominal pain radiating to the back, accompanied by nausea and discomfort after meals. Physical examination showed mild tenderness in the right upper quadrant but no signs of jaundice or peritonitis. Routine laboratory tests were normal, and ultrasound revealed gallstones measuring about 24 mm without signs of acute inflammation. Based on these findings, she was diagnosed with symptomatic cholelithiasis and scheduled for a laparoscopic cholecystectomy at Oda Hulle General Hospital.
During surgery, the team discovered that the gallbladder had a distinct S-shaped curve—confirming the presence of a sigmoid gallbladder. This unusual anatomy made it difficult to visualize and isolate the cystic structures safely. Through meticulous dissection and careful assessment of the critical view of safety, the surgeons were able to perform the laparoscopic procedure without converting to open surgery. The removed gallbladder measured 21 cm and showed chronic inflammation on histopathological examination, with no signs of malignancy.
The patient’s postoperative course was smooth. She was discharged two days after surgery and reported complete symptom resolution at her two-week follow-up. The authors noted that, in such rare anatomical presentations, there is an increased risk of bile duct injury, bleeding, or postoperative infections. However, this case demonstrated that with proper anatomical understanding and surgical vigilance, successful outcomes can be achieved even in complex scenarios.
The report further emphasizes that various gallbladder anomalies—such as the Phrygian cap, bilobed or septated gallbladders, and diverticula—can mimic pathological findings on imaging. Hence, accurate preoperative diagnosis using advanced imaging modalities like MRCP or contrast-enhanced CT is essential for differentiating these conditions and guiding surgical planning.
The authors concluded that recognizing and documenting rare anomalies like the sigmoid gallbladder is vital for improving surgical safety and outcomes. In resource-limited settings, adaptability during surgery and awareness of biliary variations become even more critical. This case serves as a reminder that detailed imaging, anatomical knowledge, and careful intraoperative assessment are key to preventing complications and ensuring patient safety during cholecystectomy.
Reference:
Abagojam, A.HA., Kebede, M.L., Zhang, L. et al. Sigmoid gallbladder in a 38-year-old female with gallstone disease: a case report. BMC Surg 25, 480 (2025). https://doi.org/10.1186/s12893-025-03183-2
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