Sigmoid gallbladder in a 38-year-old female with gallstone disease: case report and literature review

Sigmoid gallbladder in a 38-year-old female with gallstone disease: case report and literature review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Sigmoid gallbladder in a 38-year-old female with gallstone disease: case report and literature review Abduletif Haji-Ababor Abagojam, Merid Lemma Kebede, Linda Zhang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6324537/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 15 Oct, 2025 Read the published version in BMC Surgery → Version 1 posted 12 You are reading this latest preprint version Abstract Background The sigmoid gallbladder is a rare anatomic variant characterized by an S-shaped curve in its structure, often stemming from abnormal embryonic development during gestation. This anomaly complicates surgical procedures like cholecystectomy, primarily due to its convoluted shape and potential for misdiagnosis. Case studies indicate that preoperative imaging techniques, including ultrasound and MRCP, are essential for accurate diagnosis and preventing bile duct injuries. Although sigmoid gallbladders are typically asymptomatic unless associated with gallstones, thorough imaging, and surgical techniques are crucial for successful management. Case presentation This case highlights a 38-year-old female with symptoms of cholelithiasis who underwent a laparoscopic cholecystectomy at Oda Hulle General Hospital in Ethiopia. The surgery was complicated by an S-shaped gallbladder anatomy that obscured necessary structures, necessitating careful dissection to prevent bile duct injury. Postoperative recovery was uneventful, and the patient was discharged after two days. Conclusion This case underscores the impact of anatomical variations on gallstone management and the critical need for preoperative imaging, like MRCP, to navigate such complexities. In resource-limited settings, adaptability during surgery and an understanding of biliary anomalies is essential for minimizing complications. The case serves as a reminder of the need for improved anatomical awareness and documentation of gallbladder abnormalities, which could enhance surgical practices globally. Sigmoid gallbladder cholelithiasis laparoscopic cholecystectomy Oda Hulle General Hospital Ethiopia Figures Figure 1 Figure 2 Figure 3 Key Clinical Messages Recognizing the sigmoid gallbladder is crucial for avoiding complications during cholecystectomy. Surgeons should have a high suspicion for such anomalies, especially in settings with limited preoperative imaging tools. Preoperative imaging and precise surgical techniques are essential for safe cholecystectomy in anatomic variances. Successful outcomes in resource-limited situations require anatomical awareness and context-specific techniques. Introduction The gallbladder is prone to a wide range of anatomic variants, with the sigmoid gallbladder being a rare but clinically relevant form distinguished by an S-shaped curve of the body and neck [ 1 ]. While most variations, such as the Phrygian cap, are unintentional discoveries, the tortuous morphology of the sigmoid gallbladder can mask essential structures such as the cystic duct and artery, increasing the risk of iatrogenic injury during cholecystectomy [ 2 ]. Recognition of such anomalies is especially important in resource-constrained settings, where delayed diagnosis and restricted access to advanced imaging might heighten surgical risks [ 3 ]. Despite its rarity, the sigmoid gallbladder demonstrates the value of anatomic literacy in improving patient outcomes. Preoperative imaging, such as magnetic resonance cholangiopancreatography (MRCP), is critical in defining biliary anatomy and minimizing intraoperative problems [ 4 ]. However, in areas with limited resources, relying on basic ultrasonography and intraoperative adaptation becomes critical [ 5 ]. The sigmoid gallbladder's mimicking of diseases such as tumors or diverticula complicates diagnosis and necessitates increased clinical suspicion [ 6 ].To avoid bile duct injury, surgeons must balance the limitations of available imaging with precise technique, which is especially difficult in laparoscopic procedures when depth perception is limited [ 7 ]. This dichotomy of diagnostic and technical issues emphasizes the importance of context-specific solutions in controlling anatomic variations. This case of a sigmoid gallbladder in a 38-year-old Ethiopian woman with symptomatic cholelithiasis adds to the little literature on biliary abnormalities in Sub-Saharan Africa [ 8 ]. While anatomic variations are well documented worldwide, their presentation and management in low-resource settings are underreported, impeding the creation of regionally customized guidelines. This article emphasizes the need for anatomic knowledge and technical precision in a variety of clinical scenarios by describing the interaction between preoperative imaging constraints, surgical obstacles, and effective outcomes. It also pushes for increased documentation of similar cases to improve worldwide surgical practices and decrease inequities in care. Case presentation A 38-year-old black female reported to the outpatient clinic on March 2, 2025, with a six-month history of recurring, colicky right upper abdominal pain that radiated to the back and was accompanied by nausea and discomfort after eating. She denied having a fever, jaundice, or any previous history of comparable symptoms or abdominal procedures. Otherwise, she had no known chronic illnesses, no history of chronic cough, night sweats, weight loss, or appetite abnormalities, and no similar prior complaints. Her family and medical history were unremarkable; she was not taking any medications, did not use alcohol or recreational drugs, and had no history of smoking. A physical examination revealed a comfortable patient with stable vital signs, including a blood pressure of 120/80 mmHg, pulse rate of 76 beats per minute, respiration rate of 16 breaths per minute, temperature of 36.2°C, and oxygen saturation of 99% at room air. She weighed 75 kg, had a height of 170 cm, and a BMI of 26 kg/m². The conjunctivae were pink and not icteric. On abdominal examination, there was mild pain in the right upper abdominal quadrant but no guarding, rigidity, or rebound tenderness. No palpable lumps or symptoms of peritonitis were found. Other systemic exams were non-revealing. Routine lab investigations including systemic inflammatory indicators such as leukocytosis and increased C-reactive protein were missing. Further testing, including liver function tests, renal function, urine analysis, autoimmune markers, coagulation profiles, hepatotropic viral indicators (including HBVsAg and HCV Antibody), and retroviral infection screening, revealed no significant findings (Table 1 ). Abdominal ultrasonography revealed 24mm gallstones, which are morphologically abnormal, with no pericholecystic fluid on the wall. Based on the clinical and imaging results, symptomatic cholelithiasis was diagnosed, and a laparoscopic cholecystectomy was scheduled. Table 1 Serologic investigations during admission, on March 2, 2025, of a 38-year-old female with sigmoid gallstone disease. Variables Results Reference ranges Hematocrit (%) 41.5 36.0–46.0 Hemoglobin (mg/dl) 13.4 11—16.5 White cell count (per \(\:\varvec{\mu\:}\) l) 7,300 4000—15000 Neutrophil (%) 71.5 1800–7700 Lymphocyte (%) 21.8 1000–4800 Platelet (per \(\:\varvec{\mu\:}\) l) 3260,000 150,000—450000 Mean corpuscular volume (fl) 87.1 82–100 Mean corpuscular hemoglobin (pg) 32.4 26.0–34.0 Mean corpuscular hemoglobin concentration (g/dl) 35.4 31.0–37.0 Red‑cell distribution width (%) 11.2 11.5–14.5 ESR (mm/hr.) 19 0–20 Creatinine (mg/dl) 0.93 0–5—1.2 Blood urea nitrogen (mg/dl) 12.6 7—20 Sodium (mmol/L) 142 135—145 Potassium (mmol/L) 3.9 3.5—5.5 Chloride (mmol/L) 100 98—107 AST (IU/L) 43 0—40 ALT (IU/L) 37 0—41 ALP (IU/L) 195 40—130 LDH(U/L) 256 140–280 Serum Bilirubin (mg/dl) Total 1.1 0.3–1.2 Serum Bilirubin (mg/dl) direct 0.11 0.0-0.2 Prothrombin time (sec) 10.1 10—14 APTT (sec) 100.2 22—38 INR 0.84 0.7—1.2 ANA quantitative (AU/ml) 21 0–40 HIV test Non-reactive Non-reactive Serum VDRL test Non-reactive Non-reactive Hepatitis B surface antigen test Negative Negative Hepatitis C antibody test Negative Negative Serum Albumin (g/dl) 4.1 3.3–5.0 ALP = Alkaline Phosphatase; ANA = antinuclear antibody; APTT = Activated partial thromboplastin time; AST/ALT = Aspartate Transaminase/ Alanine Transaminase; ESR = Erythrocyte sedimentation rate, HIV = Human Immunodeficiency Virus; TSH = Thyroid Stimulating Hormone; VDRL = Venereal Disease Research Laboratory Differential Diagnosis The gallbladder can present with numerous anatomical variations, including the Phrygian cap, septated and duplicated gallbladders, bilobed structure, agenesis, ectopic positioning, floating gallbladder, hourglass shape, diverticula, hypoplasia, multi-septation, rudimentary forms, torsion, intrahepatic location, herniation, and others. These variations may involve different configurations and functional implications for the gallbladder, impacting diagnosis and treatment strategies. The Phrygian cap, the most common gallbladder variant (4–6% prevalence), is caused by inadequate embryological unfolding of the gallbladder fundus, resulting in a unique fold that appears pathological on imaging [ 1 ]. Unlike the sigmoid gallbladder, which has an S-shaped curvature of the body or neck, the Phrygian cap is limited to the fundus and usually maintains adequate biliary function. However, its appearance on ultrasound or CT may mimic a septated gallbladder or even a tumor, especially in oblique imaging planes [ 2 ]. Differentiation is based on detecting the fold's fundal position and the absence of additional pathological symptoms such as wall thickening or pericholecystic inflammation. Advanced modalities such as magnetic resonance cholangiopancreatography (MRCP) can help to clarify anatomy by providing multiplanar images of the biliary tree [ 4 ]. A sigmoid gallbladder should be recognized from gallbladder tumors and diverticula, which have very different therapeutic implications. Gallbladder neoplasms, such as adenomas and adenocarcinomas, frequently appear as localized wall thickening or intraluminal masses with irregular shapes, which might simulate the tortuosity of a sigmoid gallbladder [ 7 ]. Contrast-enhanced CT or MRI can help identify malignant characteristics, such as vascular enhancement or invasion of surrounding structures, that are lacking in anatomic variations [ 9 ]. Meanwhile, gallbladder diverticula—congenital or acquired outpouchings of the wall—may resemble focal curvatures but are distinguished by thin necks and communication with the lumen [ 6 ]. While large diverticula are usually asymptomatic, they can store stones or become inflamed, necessitating distinction through imaging. The clinical environment, such as symptoms of biliary colic or malignancy risk factors (e.g., porcelain gallbladder), also influences diagnostic prioritizing [ 10 ]. Finally, accurate imaging interpretation and awareness of anatomic variation are essential for preventing needless procedures or delayed diagnoses. Surgical Intervention and Postoperative follow-up Surgical Intervention and Postoperative follow-up Following written informed consent, the patient was placed in a supine position and the surgery was performed under general anesthesia. Intraoperatively, the gallbladder's sigmoid morphology made it difficult to handle and locate the cystic duct and artery, which were masked by the gallbladder's unique curvature (Figs. 1 and 2 ). Careful dissection was carried out to obtain a critical assessment of safety, ensuring clear identification of the necessary structures. Despite these hurdles, the treatment was completed laparoscopically and did not require open surgery. The removed gallbladder measured 21 cm long and had enlarged walls (Fig. 3 ). Histopathological investigation revealed chronic cholecystitis with no signs of malignancy. The patient's postoperative recovery was uneventful, and she was discharged on the second day after receiving adequate pain management and tailored food recommendations. At her two-week follow-up, she had complete symptom relief with no surgical or non-surgical complications. She is currently in good health and has resumed her normal daily routines. Discussion The sigmoid gallbladder is an uncommon anatomic variant with an S-shaped curve of the gallbladder body and neck, as opposed to the more frequent Phrygian cap, which involves fundal folding. This defect is most likely caused by abnormal embryological rotation or folding during the fourth week of gestation when the gallbladder bud elongates and canalizes from the ventral foregut [ 1 ]. While most biliary alterations are unavoidable, the sigmoid gallbladder's convoluted structure complicates cholecystectomy [ 2 ]. There are no known risk factors for sigmoid gallbladder, as most biliary abnormalities are spontaneous. Gallbladder variations affect 4–10% of the population, with the sigmoid subtype being extremely rare (< 0.1%) and primarily documented in case reports [ 11 ].In this situation, the patient's intraoperative findings of an S-shaped gallbladder are consistent with these embryologic criteria, confirming its congenital origin. We found four examples in our review using the phrase "sigmoid gallbladder" that highlight its clinical heterogeneity and diagnostic problems [ 12 – 15 ]. The first instance featured a 45-year-old female with biliary colic, demonstrating the importance of preoperative imaging (ultrasound/MRCP) in preventing bile duct injury, even in the absence of gallstones. The second patient, a 52-year-old male, demonstrated the risk of misdiagnosis since the sigmoid gallbladder originally resembled a tumor until it was accurately diagnosed with sophisticated imaging. The third example, a 38-year-old female with gallstones, necessitated a conversion to open cholecystectomy due to the abnormality, demonstrating the importance of surgical adaptation. Finally, cadaveric research discovered a sigmoid gallbladder with an abnormal cystic duct insertion, highlighting the possibility of coexisting biliary abnormalities. Collectively, these cases emphasize the significance of thorough imaging, increased surgical knowledge of anatomical variances, and additional studies to improve management techniques (Supplementary Table 1). Our case is unique in that a morphological aberration was recognized using abdominal ultrasonography despite the lack of sophisticated imaging to accurately describe the variance and reduce surgical risks. Laparoscopic excision and diagnosis were completed effectively, without the need for open surgery or any surgical complications. This case demonstrates the diagnostic hurdles and interventional limits that healthcare practitioners encounter in resource-constrained settings. Sigmoid gallbladders are usually asymptomatic unless accompanied by gallstones, which cause biliary colic, nausea, or postprandial pain [ 16 ]. Chronic inflammation from stone impaction can cause wall thickening, as demonstrated histologically in this example. Unlike acute cholecystitis, simple instances do not cause fever or leukocytosis [ 17 ]. Comparison to this case: The patient's six-month history of episodic right upper quadrant pain and nausea was consistent with classic symptomatic cholelithiasis, with no symptoms of acute inflammation. Ultrasound is still the first-line imaging modality for gallstone disease, while MRCP is better for identifying anatomic variations [ 18 ]. The S-shaped sigmoid gallbladder might be mistaken for tumors or diverticula, necessitating sophisticated imaging to prevent misdiagnosis [ 10 ].In our situation, ultrasonography detected gallstones and aberrant morphology. Laparoscopic cholecystectomy is the conventional treatment for symptomatic gallstones, but anatomic variances necessitate surgical dissection to obtain the "critical view of safety" (CVS). Conversion to open surgery may be required if anatomy is concealed, but rates are higher in low-resource countries due to poor imaging [ 19 – 20 ]. However, despite the sigmoid gallbladder's intricacy, adhering to CVS principles allowed for laparoscopic completion without conversion, demonstrating surgical skill. Successful outcomes are dependent on preoperative imaging, intraoperative flexibility, and histopathologic confirmation of benign illness [ 21 ]. Long-term follow-up is infrequently recorded; however, it is critical to rule out recurrence or undetected cancers [ 22 ].In this example, the patient's symptom remission at two weeks and benign histology are consistent with positive short-term results, however, long-term data are also available as the patient’s detailed address was well documented. This case demonstrates the diagnostic and surgical problems of a sigmoid gallbladder, highlighting the interaction of anatomic awareness, imaging, and technical expertise. It is consistent with the research on gallstone management while emphasizing discrepancies in resource-limited settings. Increased reporting of such aberrations is critical for improving global surgical procedures. Strengths and limitations This case presents a detailed account of a rare anatomic variant (sigmoid gallbladder) effectively managed in a resource-constrained setting, adding to the little literature on biliary malformations in Sub-Saharan Africa. Furthermore, using the "critical view of safety" paradigm during laparoscopic cholecystectomy reflects recognized best practices for avoiding bile duct injury. However, because this is a single-case report, generalizability is restricted, and the findings may not be representative of larger clinical or demographic trends. While ultrasonography is a practical first imaging modality in resource-constrained situations, it may cause anatomic changes to be missed when compared to advanced imaging. Conclusion The sigmoid gallbladder is an uncommon anatomical variation that poses challenges in diagnostic imaging and surgical interventions, particularly in the context of cholecystectomy. Accurate preoperative imaging, such as MRCP, is essential for proper diagnosis and surgical planning, and surgeons must take care to prevent complications like bile duct injury. A case highlighting a sigmoid gallbladder with symptomatic cholelithiasis underscores the importance of detailed preoperative assessments and surgical skills. The findings emphasize the need for heightened awareness of anatomical variations in surgical practices and the necessity for further research to enhance understanding, prevalence, and management of such anomalies. Declarations Data availability statement All the information used to describe the case is within the article. Ethical statement Written informed consent was obtained from the patient to publish this report following the journal's patient consent policy. Authors’ contributions AHA, LZ, TGW, and KNT made contributions to the first draft, conception, design, investigation, analysis, and writing. KNT, MLK, AHA, LZ, and TGW took part in the supervision, analysis, and edition of the data as well as data curation. The manuscript was modified and reviewed by all authors before being approved in its final form. Funding The authors state that they are not affiliated with any organizations and do not receive financing from them that may be relevant to the data in this publication development. Conflict of interests The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Acknowledgments We are grateful to the surgical team at Oda Hulle General Hospital for their expertise and dedication to patient care. Special thanks to the patient, who graciously provided consent for the publication of this case. References Standring S. Gallbladder and biliary tree. In: Gray’s Anatomy. 42nd ed. Elsevier; 2020. p. 1221-33. Mortelé KJ, Ros PR. Anatomic variants of the biliary tree: MR cholangiographic findings and clinical applications. AJR Am J Roentgenol. 2001;177(2):389-94. doi:10.2214/ajr.177.2.1770389. Meara JG, Leather AJM, Hagander L, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386(9993):569-624. doi:10.1016/S0140-6736(15)60160-X. Catalano OA, Sahani DV, Kalva SP, et al. MR imaging of the gallbladder: a pictorial essay. Radiographics. 2008;28(1):135-55. doi:10.1148/rg.281065183. Wiles R, Thoeni RF, Barbu ST, et al. Management and follow-up of gallbladder polyps. Eur Radiol. 2017;27(9):3856-66. doi:10.1007/s00330-017-4742-y. Golse N, Lewin M, Rode A, Sebagh M, Mabrut JY. Gallbladder diverticulum: a rare embryological remnant. Clin Res Hepatol Gastroenterol. 2012;36(6):628-31. doi:10.1016/j.clinre.2012.04.013. Jarnagin WR, Fong Y, Blumgart LH. Gallbladder cancer: comparison of patients presenting initially for definitive operation with those presenting after prior noncurative intervention. Ann Surg. 2000;232(4):557-69. doi:10.1097/00000658-200010000-00011. Bode CO, Ademuyiwa AO. Surgery in low-resource settings: implications for surgical training and standardized care. World J Surg. 2021;45(7):1987-93. doi:10.1007/s00268-021-06062-y. Mondiale de la Santé O, World Health Organization. Global leprosy update, 2017: reducing the disease burden due to leprosy–situation de la lèpre dans le monde, 2017: reduction de la charge de morbidité due à la lèpre. Weekly Epidemiological Record= Relevé épidémiologique hebdomadaire. 2018 Aug 31;93(35):445-56. Levy AD, Murakata LA, Rohrmann CA. Gallbladder carcinoma: radiologic-pathologic correlation. Radiographics. 2001;21(2):295-314. doi:10.1148/radiographics.21.2.g01mr16295. Wiles R, Thoeni RF, Barbu ST, et al. Management and follow-up of gallbladder polyps: joint guidelines between the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery (EAES), International Society of Digestive Surgery – European Federation (EFISDS), and European Society of Gastrointestinal Endoscopy (ESGE). Eur Radiol. 2017;27(9):3856-66. doi:10.1007/s00330-017-4742-y. Tagliaferri E, Bergmann H, Hammans S, Azizi A, Stüber E, Seidlmayer C. Agenesis of the gallbladder: role of clinical suspicion and magnetic resonance to avoid unnecessary surgery. Case Reports in Gastroenterology. 2017 Jan 9;10(3):819-25. Reyes Q, McLeod RL, Fernandes K, Muralidharan V, Weinberg L. Magnetic resonance cholangiopancreatography uncovering massive gallbladder mucocele in a patient with ambiguous clinical and laboratory findings: A case report. Int J Surg Case Rep. 2017;36:133–135. doi:10.1016/j.ijscr.2017.04.031. Kariya Toyota General Hospital. 65-year-old male with sigmoid gallstone ileus. Sigmoid gallstone complicated laparoscopic cholecystectomy, requiring conversion to open surgery. Demonstrated surgical challenges and the need for careful preoperative planning. Int J Surg Case Rep. 2018;49:51-54. doi:10.1016/j.ijscr.2018.06.015. Chinelli J, Moreira E, Costa J, Rodriguez G. Cystic duct draining to the right hepatic duct: a rare anatomical variant. ACS Case Reviews in Surgery. 2020;2(6). Lammert F, Gurusamy K, Ko CW, Miquel JF, Méndez-Sánchez N, Portincasa P, van Erpecum KJ. Gallstones Nat Rev Dis Primers. 2016; 2: 16024 [Internet]. 2016. Indar AA, Beckingham IJ. Acute cholecystitis. Bmj. 2002 Sep 21;325(7365):639-43. Aydın C, Üstün M, Karaca AC. Management of Gallbladder Polyps: A Tertiary Center Experience. İzmir Tepecik Eğitim Hastanesi Dergisi. 2019. Strasberg SM, Brunt ML. Rationale and use of the critical view of safety in laparoscopic cholecystectomy. Journal of the American College of Surgeons. 2010 Jul 1;211(1):132-8. Matos JT. Conhecimentos e atitudes em relação ao manejo do trauma e reanimação pediátrico em regiões com baixos recursos: um estudo entre os profissionais de saúde dos Hospitais Centrais de Moçambique (Doctoral dissertation, Universidade Eduardo Mondlane). Milas M, Deveđija S, Trkulja V. Single incision versus standard multiport laparoscopic cholecystectomy: up-dated systematic review and meta-analysis of randomized trials. the surgeon. 2014 Oct 1;12(5):271-89. Gulwani HV, Gupta S, Kaur S. Squamous cell and adenosquamous carcinoma of gall bladder: a clinicopathological study of 8 cases isolated in 94 cancers. Indian journal of surgical oncology. 2017 Dec;8:560-6. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 15 Oct, 2025 Read the published version in BMC Surgery → Version 1 posted Editorial decision: Revision requested 18 Jul, 2025 Reviews received at journal 07 Jul, 2025 Reviews received at journal 02 Jul, 2025 Reviews received at journal 30 Jun, 2025 Reviewers agreed at journal 29 Jun, 2025 Reviewers agreed at journal 24 Jun, 2025 Reviewers agreed at journal 24 Jun, 2025 Reviewers invited by journal 24 Jun, 2025 Editor invited by journal 19 Jun, 2025 Editor assigned by journal 01 Apr, 2025 Submission checks completed at journal 01 Apr, 2025 First submitted to journal 27 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6324537","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":475925340,"identity":"0ed44c5b-e46e-44a5-a437-8c8f5f3a707b","order_by":0,"name":"Abduletif Haji-Ababor Abagojam","email":"","orcid":"","institution":"Jimma University","correspondingAuthor":false,"prefix":"","firstName":"Abduletif","middleName":"Haji-Ababor","lastName":"Abagojam","suffix":""},{"id":475925341,"identity":"3d0b2612-edf5-4054-8b13-ce068c5f418f","order_by":1,"name":"Merid Lemma Kebede","email":"","orcid":"","institution":"Jimma University","correspondingAuthor":false,"prefix":"","firstName":"Merid","middleName":"Lemma","lastName":"Kebede","suffix":""},{"id":475925342,"identity":"71d7784a-ae07-49f8-90c2-8779beacdc40","order_by":2,"name":"Linda Zhang","email":"","orcid":"","institution":"Mount Sinai Hospital New York","correspondingAuthor":false,"prefix":"","firstName":"Linda","middleName":"","lastName":"Zhang","suffix":""},{"id":475925343,"identity":"7e0a7f7d-6681-472e-bc23-ba834f6bb3d3","order_by":3,"name":"Tamirat Godebo Woyimo","email":"","orcid":"","institution":"Jimma University","correspondingAuthor":false,"prefix":"","firstName":"Tamirat","middleName":"Godebo","lastName":"Woyimo","suffix":""},{"id":475925344,"identity":"3d4826de-146b-4060-95c2-e5955c15acec","order_by":4,"name":"Kedir Negesso Tukeni","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBUlEQVRIiWNgGAWjYBACgwMgBAcVbGBBvFoMG1C0nIFrwa3NGEWSsY2BsBYz9uaNhysY7sjJu7c//vBxHl9iA3vzNgmGij84tdjwHCs4eIbhmbHhmTNmkjO3sSU28Bwrk2A4g9sWG4kcg4MNDIcTN87IYWPmBWmRyDGTYGzD4zD5N2At9RvnP3/8mXcOUIv8G6CWf3i8L8ED1pIgL8FgIM3bALKFB6ilAbcWw560goMNBocNN/DkmEnOOMZm3MaTVmyRcMwYpxaD44c3f2yoOCwv33788YcPNcdk+9kPb7zxoUYOpxaoRgZYhB5jAEdmAgENYCDfAKZqiFE7CkbBKBgFIwwAAPjtVCmjmNRHAAAAAElFTkSuQmCC","orcid":"","institution":"Jimma University","correspondingAuthor":true,"prefix":"","firstName":"Kedir","middleName":"Negesso","lastName":"Tukeni","suffix":""}],"badges":[],"createdAt":"2025-03-28 03:38:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6324537/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6324537/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12893-025-03183-2","type":"published","date":"2025-10-15T15:57:08+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":85824321,"identity":"fd0180f4-2d16-4a64-858c-8354c7ced87f","added_by":"auto","created_at":"2025-07-02 07:01:09","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":34600,"visible":true,"origin":"","legend":"\u003cp\u003eAn intraoperative laparoscopic picture of the patient is shown, with the right subhepatic region (blue arrow) marked for anatomical delineation and a distended gallbladder beneath the right hepatic lobe (red arrow).\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6324537/v1/6b8a3576f5a0d760eaf5c94b.jpg"},{"id":85825773,"identity":"29f66cf6-65ee-41f5-acfa-87291b8ffca4","added_by":"auto","created_at":"2025-07-02 07:09:09","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":43708,"visible":true,"origin":"","legend":"\u003cp\u003e(a and b) Intraoperative laparoscopic images of the gallbladder's sigmoid morphology, which hindered manipulation and concealed the identification of the cystic duct and artery due to its unusual curvature.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6324537/v1/9edc074e4a6a978d947a5dbf.jpg"},{"id":85824323,"identity":"a75e17c6-bb52-49e4-8963-3f35ddb0dafe","added_by":"auto","created_at":"2025-07-02 07:01:09","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":36923,"visible":true,"origin":"","legend":"\u003cp\u003eA postoperative view of the removed gallbladder, which measures 21 cm in length (indicated by the red double-arrowed line). It has thicker walls and an S-shaped curvature of the body and neck, which confirms the final diagnosis of a sigmoid-shaped gallbladder.\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6324537/v1/e879dee0af423b054bbd1b6b.jpg"},{"id":93955921,"identity":"6d60558c-6e32-4e3a-a5e1-706af74c929d","added_by":"auto","created_at":"2025-10-20 16:06:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":660909,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6324537/v1/3fa5b5c5-dfab-47f2-82d3-ad14f17d7fec.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Sigmoid gallbladder in a 38-year-old female with gallstone disease: case report and literature review","fulltext":[{"header":"Key Clinical Messages","content":"\u003cul\u003e \u003cli\u003e \u003cp\u003eRecognizing the sigmoid gallbladder is crucial for avoiding complications during cholecystectomy.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSurgeons should have a high suspicion for such anomalies, especially in settings with limited preoperative imaging tools.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePreoperative imaging and precise surgical techniques are essential for safe cholecystectomy in anatomic variances.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSuccessful outcomes in resource-limited situations require anatomical awareness and context-specific techniques.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eThe gallbladder is prone to a wide range of anatomic variants, with the sigmoid gallbladder being a rare but clinically relevant form distinguished by an S-shaped curve of the body and neck [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. While most variations, such as the Phrygian cap, are unintentional discoveries, the tortuous morphology of the sigmoid gallbladder can mask essential structures such as the cystic duct and artery, increasing the risk of iatrogenic injury during cholecystectomy [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Recognition of such anomalies is especially important in resource-constrained settings, where delayed diagnosis and restricted access to advanced imaging might heighten surgical risks [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Despite its rarity, the sigmoid gallbladder demonstrates the value of anatomic literacy in improving patient outcomes.\u003c/p\u003e \u003cp\u003ePreoperative imaging, such as magnetic resonance cholangiopancreatography (MRCP), is critical in defining biliary anatomy and minimizing intraoperative problems [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, in areas with limited resources, relying on basic ultrasonography and intraoperative adaptation becomes critical [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The sigmoid gallbladder's mimicking of diseases such as tumors or diverticula complicates diagnosis and necessitates increased clinical suspicion [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].To avoid bile duct injury, surgeons must balance the limitations of available imaging with precise technique, which is especially difficult in laparoscopic procedures when depth perception is limited [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This dichotomy of diagnostic and technical issues emphasizes the importance of context-specific solutions in controlling anatomic variations.\u003c/p\u003e \u003cp\u003eThis case of a sigmoid gallbladder in a 38-year-old Ethiopian woman with symptomatic cholelithiasis adds to the little literature on biliary abnormalities in Sub-Saharan Africa [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. While anatomic variations are well documented worldwide, their presentation and management in low-resource settings are underreported, impeding the creation of regionally customized guidelines. This article emphasizes the need for anatomic knowledge and technical precision in a variety of clinical scenarios by describing the interaction between preoperative imaging constraints, surgical obstacles, and effective outcomes. It also pushes for increased documentation of similar cases to improve worldwide surgical practices and decrease inequities in care.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 38-year-old black female reported to the outpatient clinic on March 2, 2025, with a six-month history of recurring, colicky right upper abdominal pain that radiated to the back and was accompanied by nausea and discomfort after eating. She denied having a fever, jaundice, or any previous history of comparable symptoms or abdominal procedures. Otherwise, she had no known chronic illnesses, no history of chronic cough, night sweats, weight loss, or appetite abnormalities, and no similar prior complaints. Her family and medical history were unremarkable; she was not taking any medications, did not use alcohol or recreational drugs, and had no history of smoking. A physical examination revealed a comfortable patient with stable vital signs, including a blood pressure of 120/80 mmHg, pulse rate of 76 beats per minute, respiration rate of 16 breaths per minute, temperature of 36.2\u0026deg;C, and oxygen saturation of 99% at room air. She weighed 75 kg, had a height of 170 cm, and a BMI of 26 kg/m\u0026sup2;. The conjunctivae were pink and not icteric. On abdominal examination, there was mild pain in the right upper abdominal quadrant but no guarding, rigidity, or rebound tenderness. No palpable lumps or symptoms of peritonitis were found. Other systemic exams were non-revealing.\u003c/p\u003e \u003cp\u003eRoutine lab investigations including systemic inflammatory indicators such as leukocytosis and increased C-reactive protein were missing. Further testing, including liver function tests, renal function, urine analysis, autoimmune markers, coagulation profiles, hepatotropic viral indicators (including HBVsAg and HCV Antibody), and retroviral infection screening, revealed no significant findings (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Abdominal ultrasonography revealed 24mm gallstones, which are morphologically abnormal, with no pericholecystic fluid on the wall. Based on the clinical and imaging results, symptomatic cholelithiasis was diagnosed, and a laparoscopic cholecystectomy was scheduled.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSerologic investigations during admission, on March 2, 2025, of a 38-year-old female with sigmoid gallstone disease.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResults\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eReference ranges\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHematocrit (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e36.0\u0026ndash;46.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e11\u0026mdash;16.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite cell count (per \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\varvec{\\mu\\:}\\)\u003c/span\u003e\u003c/span\u003el)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7,300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e4000\u0026mdash;15000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutrophil (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1800\u0026ndash;7700\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymphocyte (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1000\u0026ndash;4800\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlatelet (per \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\varvec{\\mu\\:}\\)\u003c/span\u003e\u003c/span\u003el)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3260,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e150,000\u0026mdash;450000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean corpuscular volume (fl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e82\u0026ndash;100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean corpuscular hemoglobin (pg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e26.0\u0026ndash;34.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean corpuscular hemoglobin concentration (g/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e31.0\u0026ndash;37.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRed‑cell distribution width (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e11.5\u0026ndash;14.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eESR (mm/hr.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreatinine (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u0026ndash;5\u0026mdash;1.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood urea nitrogen (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e7\u0026mdash;20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSodium (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e135\u0026mdash;145\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePotassium (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e3.5\u0026mdash;5.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChloride (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e98\u0026mdash;107\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAST (IU/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u0026mdash;40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALT (IU/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u0026mdash;41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALP (IU/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e40\u0026mdash;130\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDH(U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e140\u0026ndash;280\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum Bilirubin (mg/dl) Total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.3\u0026ndash;1.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum Bilirubin (mg/dl) direct\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.0-0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProthrombin time (sec)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e10\u0026mdash;14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAPTT (sec)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e22\u0026mdash;38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eINR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.7\u0026mdash;1.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eANA quantitative (AU/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIV test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-reactive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eNon-reactive\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum VDRL test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-reactive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eNon-reactive\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepatitis B surface antigen test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepatitis C antibody test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum Albumin (g/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.3\u0026ndash;5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eALP\u0026thinsp;=\u0026thinsp;Alkaline Phosphatase; ANA\u0026thinsp;=\u0026thinsp;antinuclear antibody; APTT\u0026thinsp;=\u0026thinsp;Activated partial thromboplastin time; AST/ALT\u0026thinsp;=\u0026thinsp;Aspartate Transaminase/ Alanine Transaminase; ESR\u0026thinsp;=\u0026thinsp;Erythrocyte sedimentation rate, HIV\u0026thinsp;=\u0026thinsp;Human Immunodeficiency Virus; TSH\u0026thinsp;=\u0026thinsp;Thyroid Stimulating Hormone; VDRL\u0026thinsp;=\u0026thinsp;Venereal Disease Research Laboratory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDifferential Diagnosis\u003c/h2\u003e \u003cp\u003eThe gallbladder can present with numerous anatomical variations, including the Phrygian cap, septated and duplicated gallbladders, bilobed structure, agenesis, ectopic positioning, floating gallbladder, hourglass shape, diverticula, hypoplasia, multi-septation, rudimentary forms, torsion, intrahepatic location, herniation, and others. These variations may involve different configurations and functional implications for the gallbladder, impacting diagnosis and treatment strategies. The Phrygian cap, the most common gallbladder variant (4\u0026ndash;6% prevalence), is caused by inadequate embryological unfolding of the gallbladder fundus, resulting in a unique fold that appears pathological on imaging [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Unlike the sigmoid gallbladder, which has an S-shaped curvature of the body or neck, the Phrygian cap is limited to the fundus and usually maintains adequate biliary function. However, its appearance on ultrasound or CT may mimic a septated gallbladder or even a tumor, especially in oblique imaging planes [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Differentiation is based on detecting the fold's fundal position and the absence of additional pathological symptoms such as wall thickening or pericholecystic inflammation. Advanced modalities such as magnetic resonance cholangiopancreatography (MRCP) can help to clarify anatomy by providing multiplanar images of the biliary tree [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA sigmoid gallbladder should be recognized from gallbladder tumors and diverticula, which have very different therapeutic implications. Gallbladder neoplasms, such as adenomas and adenocarcinomas, frequently appear as localized wall thickening or intraluminal masses with irregular shapes, which might simulate the tortuosity of a sigmoid gallbladder [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Contrast-enhanced CT or MRI can help identify malignant characteristics, such as vascular enhancement or invasion of surrounding structures, that are lacking in anatomic variations [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Meanwhile, gallbladder diverticula\u0026mdash;congenital or acquired outpouchings of the wall\u0026mdash;may resemble focal curvatures but are distinguished by thin necks and communication with the lumen [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. While large diverticula are usually asymptomatic, they can store stones or become inflamed, necessitating distinction through imaging. The clinical environment, such as symptoms of biliary colic or malignancy risk factors (e.g., porcelain gallbladder), also influences diagnostic prioritizing [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Finally, accurate imaging interpretation and awareness of anatomic variation are essential for preventing needless procedures or delayed diagnoses.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSurgical Intervention and Postoperative follow-up\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003eSurgical Intervention and Postoperative follow-up\u003c/div\u003e \u003cp\u003eFollowing written informed consent, the patient was placed in a supine position and the surgery was performed under general anesthesia. Intraoperatively, the gallbladder's sigmoid morphology made it difficult to handle and locate the cystic duct and artery, which were masked by the gallbladder's unique curvature (Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eCareful dissection was carried out to obtain a critical assessment of safety, ensuring clear identification of the necessary structures. Despite these hurdles, the treatment was completed laparoscopically and did not require open surgery. The removed gallbladder measured 21 cm long and had enlarged walls (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eHistopathological investigation revealed chronic cholecystitis with no signs of malignancy. The patient's postoperative recovery was uneventful, and she was discharged on the second day after receiving adequate pain management and tailored food recommendations. At her two-week follow-up, she had complete symptom relief with no surgical or non-surgical complications. She is currently in good health and has resumed her normal daily routines.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe sigmoid gallbladder is an uncommon anatomic variant with an S-shaped curve of the gallbladder body and neck, as opposed to the more frequent Phrygian cap, which involves fundal folding. This defect is most likely caused by abnormal embryological rotation or folding during the fourth week of gestation when the gallbladder bud elongates and canalizes from the ventral foregut [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. While most biliary alterations are unavoidable, the sigmoid gallbladder's convoluted structure complicates cholecystectomy [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. There are no known risk factors for sigmoid gallbladder, as most biliary abnormalities are spontaneous. Gallbladder variations affect 4\u0026ndash;10% of the population, with the sigmoid subtype being extremely rare (\u0026lt;\u0026thinsp;0.1%) and primarily documented in case reports [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].In this situation, the patient's intraoperative findings of an S-shaped gallbladder are consistent with these embryologic criteria, confirming its congenital origin.\u003c/p\u003e \u003cp\u003eWe found four examples in our review using the phrase \"sigmoid gallbladder\" that highlight its clinical heterogeneity and diagnostic problems [\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The first instance featured a 45-year-old female with biliary colic, demonstrating the importance of preoperative imaging (ultrasound/MRCP) in preventing bile duct injury, even in the absence of gallstones. The second patient, a 52-year-old male, demonstrated the risk of misdiagnosis since the sigmoid gallbladder originally resembled a tumor until it was accurately diagnosed with sophisticated imaging. The third example, a 38-year-old female with gallstones, necessitated a conversion to open cholecystectomy due to the abnormality, demonstrating the importance of surgical adaptation. Finally, cadaveric research discovered a sigmoid gallbladder with an abnormal cystic duct insertion, highlighting the possibility of coexisting biliary abnormalities.\u003c/p\u003e \u003cp\u003eCollectively, these cases emphasize the significance of thorough imaging, increased surgical knowledge of anatomical variances, and additional studies to improve management techniques (Supplementary Table\u0026nbsp;1). Our case is unique in that a morphological aberration was recognized using abdominal ultrasonography despite the lack of sophisticated imaging to accurately describe the variance and reduce surgical risks. Laparoscopic excision and diagnosis were completed effectively, without the need for open surgery or any surgical complications. This case demonstrates the diagnostic hurdles and interventional limits that healthcare practitioners encounter in resource-constrained settings.\u003c/p\u003e \u003cp\u003eSigmoid gallbladders are usually asymptomatic unless accompanied by gallstones, which cause biliary colic, nausea, or postprandial pain [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Chronic inflammation from stone impaction can cause wall thickening, as demonstrated histologically in this example. Unlike acute cholecystitis, simple instances do not cause fever or leukocytosis [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Comparison to this case: The patient's six-month history of episodic right upper quadrant pain and nausea was consistent with classic symptomatic cholelithiasis, with no symptoms of acute inflammation.\u003c/p\u003e \u003cp\u003eUltrasound is still the first-line imaging modality for gallstone disease, while MRCP is better for identifying anatomic variations [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The S-shaped sigmoid gallbladder might be mistaken for tumors or diverticula, necessitating sophisticated imaging to prevent misdiagnosis [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].In our situation, ultrasonography detected gallstones and aberrant morphology. Laparoscopic cholecystectomy is the conventional treatment for symptomatic gallstones, but anatomic variances necessitate surgical dissection to obtain the \"critical view of safety\" (CVS). Conversion to open surgery may be required if anatomy is concealed, but rates are higher in low-resource countries due to poor imaging [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. However, despite the sigmoid gallbladder's intricacy, adhering to CVS principles allowed for laparoscopic completion without conversion, demonstrating surgical skill.\u003c/p\u003e \u003cp\u003eSuccessful outcomes are dependent on preoperative imaging, intraoperative flexibility, and histopathologic confirmation of benign illness [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Long-term follow-up is infrequently recorded; however, it is critical to rule out recurrence or undetected cancers [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].In this example, the patient's symptom remission at two weeks and benign histology are consistent with positive short-term results, however, long-term data are also available as the patient\u0026rsquo;s detailed address was well documented. This case demonstrates the diagnostic and surgical problems of a sigmoid gallbladder, highlighting the interaction of anatomic awareness, imaging, and technical expertise. It is consistent with the research on gallstone management while emphasizing discrepancies in resource-limited settings. Increased reporting of such aberrations is critical for improving global surgical procedures.\u003c/p\u003e\n\u003ch3\u003eStrengths and limitations\u003c/h3\u003e\n\u003cp\u003eThis case presents a detailed account of a rare anatomic variant (sigmoid gallbladder) effectively managed in a resource-constrained setting, adding to the little literature on biliary malformations in Sub-Saharan Africa. Furthermore, using the \"critical view of safety\" paradigm during laparoscopic cholecystectomy reflects recognized best practices for avoiding bile duct injury. However, because this is a single-case report, generalizability is restricted, and the findings may not be representative of larger clinical or demographic trends. While ultrasonography is a practical first imaging modality in resource-constrained situations, it may cause anatomic changes to be missed when compared to advanced imaging.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe sigmoid gallbladder is an uncommon anatomical variation that poses challenges in diagnostic imaging and surgical interventions, particularly in the context of cholecystectomy. Accurate preoperative imaging, such as MRCP, is essential for proper diagnosis and surgical planning, and surgeons must take care to prevent complications like bile duct injury. A case highlighting a sigmoid gallbladder with symptomatic cholelithiasis underscores the importance of detailed preoperative assessments and surgical skills. The findings emphasize the need for heightened awareness of anatomical variations in surgical practices and the necessity for further research to enhance understanding, prevalence, and management of such anomalies.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the information used to describe the case is within the article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient to publish this report following the journal\u0026apos;s patient consent policy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAHA, LZ, TGW, and KNT made contributions to the first draft, conception, design, investigation, analysis, and writing. KNT, MLK, AHA, LZ, and TGW took part in the supervision, analysis, and edition of the data as well as data curation. The manuscript was modified and reviewed by all authors before being approved in its final form.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors state that they are not affiliated with any organizations and do not receive financing from them that may be relevant to the data in this publication development.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;We are grateful to the surgical team at Oda Hulle General Hospital for their expertise and dedication to patient care. Special thanks to the patient, who graciously provided consent for the publication of this case.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eStandring S. Gallbladder and biliary tree. In: Gray\u0026rsquo;s Anatomy. 42nd ed. Elsevier; 2020. p. 1221-33.\u003c/li\u003e\n\u003cli\u003eMortel\u0026eacute; KJ, Ros PR. Anatomic variants of the biliary tree: MR cholangiographic findings and clinical applications. AJR Am J Roentgenol. 2001;177(2):389-94. doi:10.2214/ajr.177.2.1770389.\u003c/li\u003e\n\u003cli\u003eMeara JG, Leather AJM, Hagander L, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386(9993):569-624. doi:10.1016/S0140-6736(15)60160-X.\u003c/li\u003e\n\u003cli\u003eCatalano OA, Sahani DV, Kalva SP, et al. MR imaging of the gallbladder: a pictorial essay. Radiographics. 2008;28(1):135-55. doi:10.1148/rg.281065183.\u003c/li\u003e\n\u003cli\u003eWiles R, Thoeni RF, Barbu ST, et al. Management and follow-up of gallbladder polyps. Eur Radiol. 2017;27(9):3856-66. doi:10.1007/s00330-017-4742-y.\u003c/li\u003e\n\u003cli\u003eGolse N, Lewin M, Rode A, Sebagh M, Mabrut JY. Gallbladder diverticulum: a rare embryological remnant. Clin Res Hepatol Gastroenterol. 2012;36(6):628-31. doi:10.1016/j.clinre.2012.04.013.\u003c/li\u003e\n\u003cli\u003eJarnagin WR, Fong Y, Blumgart LH. Gallbladder cancer: comparison of patients presenting initially for definitive operation with those presenting after prior noncurative intervention. Ann Surg. 2000;232(4):557-69. doi:10.1097/00000658-200010000-00011.\u003c/li\u003e\n\u003cli\u003eBode CO, Ademuyiwa AO. Surgery in low-resource settings: implications for surgical training and standardized care. World J Surg. 2021;45(7):1987-93. doi:10.1007/s00268-021-06062-y.\u003c/li\u003e\n\u003cli\u003eMondiale de la Sant\u0026eacute; O, World Health Organization. Global leprosy update, 2017: reducing the disease burden due to leprosy\u0026ndash;situation de la l\u0026egrave;pre dans le monde, 2017: reduction de la charge de morbidit\u0026eacute; due \u0026agrave; la l\u0026egrave;pre. Weekly Epidemiological Record= Relev\u0026eacute; \u0026eacute;pid\u0026eacute;miologique hebdomadaire. 2018 Aug 31;93(35):445-56.\u003c/li\u003e\n\u003cli\u003eLevy AD, Murakata LA, Rohrmann CA. Gallbladder carcinoma: radiologic-pathologic correlation. Radiographics. 2001;21(2):295-314. doi:10.1148/radiographics.21.2.g01mr16295.\u003c/li\u003e\n\u003cli\u003eWiles R, Thoeni RF, Barbu ST, et al. Management and follow-up of gallbladder polyps: joint guidelines between the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery (EAES), International Society of Digestive Surgery \u0026ndash; European Federation (EFISDS), and European Society of Gastrointestinal Endoscopy (ESGE). Eur Radiol. 2017;27(9):3856-66. doi:10.1007/s00330-017-4742-y.\u003c/li\u003e\n\u003cli\u003eTagliaferri E, Bergmann H, Hammans S, Azizi A, St\u0026uuml;ber E, Seidlmayer C. Agenesis of the gallbladder: role of clinical suspicion and magnetic resonance to avoid unnecessary surgery. Case Reports in Gastroenterology. 2017 Jan 9;10(3):819-25.\u003c/li\u003e\n\u003cli\u003eReyes Q, McLeod RL, Fernandes K, Muralidharan V, Weinberg L. Magnetic resonance cholangiopancreatography uncovering massive gallbladder mucocele in a patient with ambiguous clinical and laboratory findings: A case report. Int J Surg Case Rep. 2017;36:133\u0026ndash;135. doi:10.1016/j.ijscr.2017.04.031.\u003c/li\u003e\n\u003cli\u003eKariya Toyota General Hospital. 65-year-old male with sigmoid gallstone ileus. Sigmoid gallstone complicated laparoscopic cholecystectomy, requiring conversion to open surgery. Demonstrated surgical challenges and the need for careful preoperative planning. Int J Surg Case Rep. 2018;49:51-54. doi:10.1016/j.ijscr.2018.06.015.\u003c/li\u003e\n\u003cli\u003eChinelli J, Moreira E, Costa J, Rodriguez G. Cystic duct draining to the right hepatic duct: a rare anatomical variant. ACS Case Reviews in Surgery. 2020;2(6).\u003c/li\u003e\n\u003cli\u003eLammert F, Gurusamy K, Ko CW, Miquel JF, M\u0026eacute;ndez-S\u0026aacute;nchez N, Portincasa P, van Erpecum KJ. Gallstones Nat Rev Dis Primers. 2016; 2: 16024 [Internet]. 2016. \u003c/li\u003e\n\u003cli\u003eIndar AA, Beckingham IJ. Acute cholecystitis. Bmj. 2002 Sep 21;325(7365):639-43. \u003c/li\u003e\n\u003cli\u003eAydın C, \u0026Uuml;st\u0026uuml;n M, Karaca AC. Management of Gallbladder Polyps: A Tertiary Center Experience. İzmir Tepecik Eğitim Hastanesi Dergisi. 2019.\u003c/li\u003e\n\u003cli\u003eStrasberg SM, Brunt ML. Rationale and use of the critical view of safety in laparoscopic cholecystectomy. Journal of the American College of Surgeons. 2010 Jul 1;211(1):132-8.\u003c/li\u003e\n\u003cli\u003eMatos JT. Conhecimentos e atitudes em rela\u0026ccedil;\u0026atilde;o ao manejo do trauma e reanima\u0026ccedil;\u0026atilde;o pedi\u0026aacute;trico em regi\u0026otilde;es com baixos recursos: um estudo entre os profissionais de sa\u0026uacute;de dos Hospitais Centrais de Mo\u0026ccedil;ambique (Doctoral dissertation, Universidade Eduardo Mondlane).\u003c/li\u003e\n\u003cli\u003eMilas M, Deveđija S, Trkulja V. Single incision versus standard multiport laparoscopic cholecystectomy: up-dated systematic review and meta-analysis of randomized trials. the surgeon. 2014 Oct 1;12(5):271-89. \u003c/li\u003e\n\u003cli\u003eGulwani HV, Gupta S, Kaur S. Squamous cell and adenosquamous carcinoma of gall bladder: a clinicopathological study of 8 cases isolated in 94 cancers. Indian journal of surgical oncology. 2017 Dec;8:560-6.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Sigmoid gallbladder, cholelithiasis, laparoscopic cholecystectomy, Oda Hulle General Hospital, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-6324537/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6324537/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sigmoid gallbladder is a rare anatomic variant characterized by an S-shaped curve in its structure, often stemming from abnormal embryonic development during gestation. This anomaly complicates surgical procedures like cholecystectomy, primarily due to its convoluted shape and potential for misdiagnosis. Case studies indicate that preoperative imaging techniques, including ultrasound and MRCP, are essential for accurate diagnosis and preventing bile duct injuries. Although sigmoid gallbladders are typically asymptomatic unless associated with gallstones, thorough imaging, and surgical techniques are crucial for successful management.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis case highlights a 38-year-old female with symptoms of cholelithiasis who underwent a laparoscopic cholecystectomy at Oda Hulle General Hospital in Ethiopia. The surgery was complicated by an S-shaped gallbladder anatomy that obscured necessary structures, necessitating careful dissection to prevent bile duct injury. Postoperative recovery was uneventful, and the patient was discharged after two days.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis case underscores the impact of anatomical variations on gallstone management and the critical need for preoperative imaging, like MRCP, to navigate such complexities. In resource-limited settings, adaptability during surgery and an understanding of biliary anomalies is essential for minimizing complications. The case serves as a reminder of the need for improved anatomical awareness and documentation of gallbladder abnormalities, which could enhance surgical practices globally.\u003c/p\u003e","manuscriptTitle":"Sigmoid gallbladder in a 38-year-old female with gallstone disease: case report and literature review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-02 07:01:04","doi":"10.21203/rs.3.rs-6324537/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-18T09:27:48+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-07T09:51:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-02T11:04:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-30T19:40:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"133354909726124280945059234075520346933","date":"2025-06-29T08:23:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"338484641119964913920764931409592849327","date":"2025-06-24T18:57:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"270470951631630185194953883482151137567","date":"2025-06-24T10:52:07+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-24T08:13:42+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-19T11:38:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-01T06:37:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-01T06:37:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Surgery","date":"2025-03-28T03:33:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7e3927f8-df2c-45b0-a43e-7d737a5f1a69","owner":[],"postedDate":"July 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-20T15:59:51+00:00","versionOfRecord":{"articleIdentity":"rs-6324537","link":"https://doi.org/10.1186/s12893-025-03183-2","journal":{"identity":"bmc-surgery","isVorOnly":false,"title":"BMC Surgery"},"publishedOn":"2025-10-15 15:57:08","publishedOnDateReadable":"October 15th, 2025"},"versionCreatedAt":"2025-07-02 07:01:04","video":"","vorDoi":"10.1186/s12893-025-03183-2","vorDoiUrl":"https://doi.org/10.1186/s12893-025-03183-2","workflowStages":[]},"version":"v1","identity":"rs-6324537","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6324537","identity":"rs-6324537","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}