Unexpected Congenital Gallbladder Malformation Discovered During Laparoscopic Cholecystectomy: A Case Report

Abstract

Background: Congenital anomalies of the gallbladder are rare developmental variations that may affect its size, shape, number, or anatomical position. Most remain clinically silent and are detected incidentally during imaging or surgery. Despite their rarity, these anomalies are of considerable surgical importance because they may complicate laparoscopic cholecystectomy and increase the risk of biliary injury if not recognized intraoperatively. Case Presentation: We report the case of a 19-year-old woman with no significant past medical history who presented with intermittent right upper quadrant abdominal pain associated with vomiting for one month. She had no fever, jaundice, or bowel disturbances. Laboratory investigations revealed mild hepatocellular cytolysis without cholestasis. Abdominal ultrasonography demonstrated a multilithiasic gallbladder without signs of acute cholecystitis or bile duct dilatation. The patient underwent elective laparoscopic cholecystectomy. Intraoperatively, unusual resistance was encountered during gallbladder extraction, prompting the use of a retrograde dissection approach and enlargement of the trocar site to facilitate specimen retrieval. Macroscopic examination of the opened specimen revealed an unexpected congenital morphological anomaly characterized by focal thickening of the gallbladder fundus associated with luminal narrowing, resulting in a pear-shaped configuration. The postoperative course was uneventful, and the patient recovered without complications. Conclusion: Congenital gallbladder anomalies, although uncommon, are clinically relevant because they may be encountered unexpectedly during routine biliary surgery. Preoperative imaging may fail to identify subtle morphological variations. Surgeons should therefore maintain a high index of suspicion when operative findings appear atypical. Careful dissection, strict adherence to the critical view of safety, and readiness to modify the operative strategy are essential to ensure safe management and avoid bile duct injury.