Laparoscopic cholecystectomy has been widely performed as the gold standard for patients suffering with symptomatic gallstone disease. However, conversion to open cholecystectomy is a dilemma when the surgeon encounters a variant biliary anomaly. A gallbladder lying to the left of the round ligament represents a rare congenital anomaly, which is termed as a left-sided gallbladder. The true left-sided gallbladder, situated on the inferior aspect of the left lobe of the liver, is extremely rare and this represents a truly ectopic gallbladder that may developmentally arise as a second gallbladder from the left hepatic duct. This is accompanied by the disappearance of the normal gallbladder on the right side. We report here on 2 cases of left-sided gallbladder that were successfully treated with laparoscopic cholecystectomy at Hallym Medical Center. In both cases, the true left-sided gallbladders were identified intraoperatively. The round ligament was indeed located in its normal position, and the gallbladder was located to the left of the round ligament, which is a type of malposition known as sinistroposition. The operation was carried out in the usual manner with the trocars placed their usual location. Although operations can be carried out with using the standard port sites, a better arrangement for laparoscopic cholecystectomy consists of more medial positioning of the gallbladder-retracting port and placement of the right hand operating port to the left side of the round ligament.
Cholecystectomy ; Cholecystectomy, Laparoscopic ; Deception ; Gallbladder ; Gallbladder Diseases ; Gallstones ; Hand ; Hepatic Duct, Common ; Humans ; Liver ; Round Ligament of Uterus ; Round Ligaments ; Stress, Psychological ; Surgical Instruments

A preduodenal portal vein is a rare anomaly. A left-sided gallbladder is also a rare anatomical variant that may be occasionally combined with a preduodenal portal vein. We report here a patient with multiple biliary stones whose preduodenal portal vein was discovered at operation. The anomaly was a preduodenal portal vein associated with a left-sided gallbladder, which is very rare. This is the first case reported in Korea. An abnormal location of the round ligament to the right side can make the gallbladder appear to be a left-sided gallbladder. Our case belongs to this category. This patient had multiple biliary stones in the intrahepatic duct, the common bile duct, and the gallbladder. We treated him with a cholecystec tomy, choledochotomy, and choledochoscopic stone extraction using a basket, and electrohydraulic lithotripter. All procedures were done using a laparoscopic method. The patient was treated well with no complication.
Common Bile Duct ; Gallbladder* ; Humans ; Korea ; Portal Vein* ; Round Ligament of Uterus ; Round Ligaments

In females, a small evagination of parietal peritoneum accompanies the round ligament through the inguinal ring into the inguinal canal and is called the canal of Nuck; it is homologous to the process vaginalis in males. If it fails to undergo complete obliteration, an indirect inguinal hernia or a hydrocele of the canal of Nuck can occur. We report three cases of this rare developmental disorder, discuss the CT findings and its use in the diagnosis of a hydrocele of the canal of Nuck.
Female ; Hernia, Inguinal ; Humans ; Inguinal Canal ; Male ; Peritoneum ; Round Ligament of Uterus ; Round Ligaments

PURPOSE: On the basis of CT findings, to differentiate between solid ovarian tumor and uterine subserosalmyoma. MATERIALS AND METHODS: In eight surgically proven cases of solid ovarian tumor and in ten uterinesubserosal myoma patients, contrast-enhanced CT images were obtained. Two genitourinary radiologists reviewed thefindings with regard to degree of enhancement of the mass as compared with enhancement of uterine myometrium,thickening of round ligaments, visualization of normal ovaries, contour of the mass, and the presence of ascitesin the pelvic cavity. RESULTS: Six of eight ovarian tumors but only two of ten uterine myomas were less enhancedthan normal uterine myometrium (p <0.05). Pelvic ascites were seen in six of eight ovarian tumors, but in only oneof ten uterine myomas (p<0.05). Three of 16 ovaries in ovarian tumor patients, but 12 of 20 ovaries in uterinemyoma patients, were normal (p<0.05). Six of 16 round ligaments of the uterus in ovarian tumor patients, were thichened but 11 of 20 round ligaments in uterine myoma patients, were thickened (p>0.05). The contour of themass was lobulated in two of eight ovarian tumor patients, but in five of ten uterine myoma patients (p>0.05). CONCLUSION: CT findings suggestive of solid ovarian tumor were less contrast enhancement of the mass than ofnormal uterine myometrium, pelvic ascites, and nonvisualization of normal ovary.
Animals ; Ascites ; Female ; Humans ; Leiomyoma* ; Mice ; Myoma ; Myometrium ; Ovary ; Round Ligament of Uterus ; Round Ligaments ; Tomography, X-Ray Computed ; Uterus

Round ligament varicosities during pregnancy are rare, and can easily be mistaken for an inguinal hernia. On physical examination, round ligament varicosities and groin hernia are difficult to distinguish. The diagnosis of round ligament varicosities can be established on gray-scale and color Doppler sonography. We experienced a case of round ligament varicosities in which a 29-year-old woman presented symptoms at 36 weeks gestation. The patient was diagnosed using Doppler sonography, managed with conservative therapy, and had an uncomplicated vaginal delivery at 40 weeks. The symptoms were resolved completely by two weeks postpartum. We report a case of round ligament varicosities that was diagnosed at 36 weeks of gestation with a review of the literature.
Adult ; Female ; Groin ; Hernia ; Hernia, Inguinal ; Humans ; Physical Examination ; Postpartum Period ; Pregnancy ; Round Ligament of Uterus ; Round Ligaments

Myolipoma is a rare biphasic, benign neoplasm that consists of mature adipocytes and smooth muscle cells. It is well-demarcated, with a soft to slimy yellow-white cut surface. Clinically it most often occurs within soft tissue in the abdominal cavity or retroperitoneum, but other locations such as the round ligaments, pericardium, and eyelid have been reported. We herein report a rare case of myolipoma which arose on the right upper lip area in a 68-year-old female.
Abdominal Cavity ; Adipocytes ; Aged ; Eyelids ; Female ; Humans ; Lip* ; Myocytes, Smooth Muscle ; Pericardium ; Round Ligaments ; Round Ligament of Uterus

Round ligament varices during pregnancy are an important part of the differential diagnosis of inguinal hernia as they may cause symptoms and clinical features that are similar to those of inguinal hernia. When this condition is correctly diagnosed, an unnecessary operation may be prevented. The diagnosis of round ligament varices should be considered for pregnant women who present with a palpable mass in the groin. We describe here a case of round ligament varices that presented during pregnancy and this was readily diagnosed with Doppler sonography.
Diagnosis, Differential ; Female ; Groin ; Hernia, Inguinal ; Humans ; Pregnancy ; Pregnant Women ; Round Ligament of Uterus ; Round Ligaments ; Varicose Veins

OBJECTIVE: To optimize a technique and evaluate the outcomes of total laparoscopic hysterectomy (TLH) performed by conventional intracorporeal suture and ligature under the 3-port method. METHODS: Eighty six patients had TLH at our hospital between July 1998 and June 2000 due to gynecologic benignancies. Operation procedures, the type and number of suture and ligature and the operation time were analyzed through reviewing of their medical records and operation video tapes. RESULTS: Overall operation time was 93.2 +/- 25.3 (mean +/- SD) minutes. The mean lapsed time was 19.8 +/- 8.5 minutes for securing and dividing the round ligaments, infundibulopelivic or ovarian ligaments, 21.39.3 minutes for securing and dividing the uterine vessels, cardinal and uterosacral ligaments, 18.7 +/- 6.2 minutes for vaginal vault support and closure, 12.1 +/- 6.4 minutes for peritoneal approximation and final inspection. Overall number of suture ligature was 26.8 +/- 2.9. The mean number of suture ligature was 5.5 +/- 1.7 for securing and dividing the round ligaments and infundibulopelivic or ovarian ligaments, 4.2 +/- 1.2 for securing and dividing the uterine vessels, cardinal and uterosacral ligaments, 5.2 +/- 0.9 for vaginal vault support and closure, 12.0 +/- 1.8 for peritoneal closure and final laparoscopic inspection. The uterine weight was 205 +/- 100.3 (range: 50.0-530.0) g. No conversion to laparotomy and major operative complications were occurred except for a case of postoperative transient voiding difficulty and a case of postoperative transfusion. CONCLUSION: TLH with the 3-port method can be performed safely and reasonably in the technical aspect and operation time by using conventional intracorporeal suture and ligature. Operation techniques could be optimized more especially in the procedure of vaginal and peritoneal closure to get the shorter operation time.
Humans ; Hysterectomy* ; Laparotomy ; Ligaments ; Ligation* ; Medical Records ; Round Ligament of Uterus ; Sutures*

There are various causes of a painful palpable mass in the groin during pregnancy. The differential diagnoses of an inguinal mass include hernia, lymphadenopathy, mesothelial cyst, cystic lymphangioma, neoplasms (lipoma, leiomyoma and sarcoma), endometriosis, embryonic remnants and round ligament varicosities. Among them, round ligament varicosities can be easily misdiagnosed as an inguinal hernia in a pregnant woman. These lesions should be managed conservatively because they resolve spontaneously during the postpartum period. Ultrasonography can help make the diagnosis of round ligament varicosities and so prevent unnecessary surgical intervention and the associated morbidity. Herein we report on a case of round ligament varicosities that presented during pregnancy and this condition was readily diagnosed via Doppler sonography.
Diagnosis, Differential ; Endometriosis ; Female ; Groin ; Hernia ; Hernia, Inguinal ; Humans ; Leiomyoma ; Lymphangioma, Cystic ; Lymphatic Diseases ; Postpartum Period ; Pregnancy ; Pregnant Women ; Round Ligament of Uterus ; Round Ligaments

Left-sided gallbladder, a rare congenital anomaly, is defined as a gallbladder located to the left of the round ligament. Rarer is the definitely diseased left-sided gallbladder in the literature. The authors experienced two true type cases of the left-sided gallbladder. One case was associated with portal vein anomaly.
Gallbladder* ; Portal Vein ; Round Ligaments