Segmental Gangrene in an Hourglass Gallbladder: A Rare Morphological Variant with Surgical Implications

Abstract

Background: Hourglass gallbladder is a rare anatomical variant characterized by a constriction dividing the gallbladder into two compartments. It may be congenital or acquired and is frequently associated with chronic inflammation. Compartmentalized pathology within such a variant is exceedingly uncommon. Case Presentation: A 70-year-old male presented with a one-day history of right upper quadrant pain, fever, and vomiting. Ultrasonography suggested acute cholecystitis with a bilobed gallbladder. Magnetic resonance imaging demonstrated an hourglass configuration with a constricted mid-body separating the fundal and neck compartments. Management and Outcome: The patient underwent laparoscopic cholecystectomy. Intraoperatively, gangrene was confined to the fundal compartment, while the distal segment remained viable. The critical view of safety was achieved, and the procedure was completed laparoscopically without complications. Histopathological examination confirmed segmental gangrenous cholecystitis. Conclusion: Selective segmental gangrene in an hourglass gallbladder is an extremely rare entity and poses diagnostic as well as intraoperative challenges. This case underscores the importance of recognizing anatomical variants, correlating preoperative imaging with intraoperative findings, and adhering to meticulous surgical technique to ensure safe outcomes.