胆囊浆膜面附加肝组织的病例分析

Objective To explore the clinical characteristics, diagnostic challenges, and surgical management strategies of hepatic tissue attached to the gallbladder serosal surface, providing practical evidence for the clinical diagnosis and treatment of rare similar cases. Methods A retrospective analysis was conducted on the clinical data of a patient with hepatic tissue attached to the gallbladder serosal surface, including medical history, physical examination, imaging findings, surgical details, and pathological results. Systematic discussion was also performed based on relevant literature. Results A 25-year-old female patient was admitted due to right upper abdominal pain and bloating lasting 15 days, with recent aggravation over a week. Abdominal ultrasound indicated gallstones, while abdominal CT scan revealed uneven thickening of the gallbladder fundus wall(1.5 cm×2.6 cm, CT value 38 HU). Under general anesthesia, laparoscopic cholecystectomy was performed. Intraoperative exploration revealed hepatic tissue attached to the serosal surface of the gallbladder fundus, connected to the right lobe of the liver via a vascular pedicle. After assessing the risk of vascular pedicle torsion and ischemic necrosis associated with retaining the attached hepatic tissue, the procedure involved vascular pedicle ligation combined with cholecystectomy and resection of the attached hepatic tissue. Postoperative pathology confirmed gallstones, chronic cholecystitis, gallbladder adenomyomatosis, and adhesion of hepatic tissue to the gallbladder serosal surface. The patient recovered well postoperatively, with no complications during a one-month follow-up. Conclusion Hepatic tissue attached to the gallbladder serosal surface is clinically rare, with preoperative imaging often missing the diagnosis, making intraoperative exploration the key to definitive diagnosis. For cases connected to the main liver via a vascular pedicle, the “vascular pedicle ligation combined with joint resection” approach effectively avoids complications and improves prognosis.