Topographic anatomy of the gallbladder

Topography and projections onto the abdominal wall

The gallbladder is located on the inferior surface of the liver. It lies within a specialized depression — the gallbladder fossa (fossa vesicae felleae), which serves as the anatomical boundary between the right and quadrate lobes of the liver.

For surgical access and clinical examination, it is crucial to know the projection of the gallbladder fundus onto the anterior abdominal wall. Several landmarks exist:

• Primary point: located at the angle formed by the intersection of the lateral border of the right rectus abdominis muscle and the right costal margin (at the junction of the 9th and 10th costal cartilages).
• Secondary projection: the point of intersection of the right parasternal line with a horizontal line connecting the anterior ends of the 10th ribs.
• In obese individuals: the intersection of the right costal margin and a line drawn from the apex of the right axillary fossa to the umbilicus is used.

Structure, dimensions, and peritoneal relations

The organ has a characteristic pear shape. Its average length is 7–8 cm, the diameter at its widest part is 2–3 cm, and its capacity ranges between 40–60 cm³.

Three main parts are distinguished in its structure:

1. Fundus (fundus) — slightly protrudes beyond the inferior margin of the liver.
2. Body (corpus) — the main part of the reservoir.
3. Neck (collum) — the narrowed part that directly transitions into the cystic duct (ductus cysticus).

Peritoneal relations: In most cases, the organ is located mesoperitoneally, meaning it is covered by the peritoneum on three sides (with the fundus covered on all sides). The superior wall of the gallbladder lacks a peritoneal covering and adheres directly to the liver tissue. A layer of loose fibrous connective tissue lies between the fascial sheath of the gallbladder and the hepatic parenchyma. This anatomical feature has practical significance, allowing the surgeon to relatively easily dissect the gallbladder subserosally during a cholecystectomy.

Syntopy (relations with neighboring organs): The free inferior wall and fundus face the abdominal cavity. They are in close contact with the transverse colon, the pyloric part of the stomach, and the duodenum. With prolonged inflammation in this area, adhesions and pathological internal biliary fistulas can form, through which large gallstones can migrate into the intestinal lumen.

Blood supply, venous and lymphatic drainage

Arterial blood supply is provided by the cystic artery (a. cystica).

• Origin: Classically, it branches off from the right hepatic artery.
• Variations of origin: The artery may originate from the proper hepatic artery, left hepatic artery, or even the gastroduodenal artery. Knowing these variations is critical for safe vessel ligation during surgery.
• Branching: Upon reaching the neck of the gallbladder, the artery runs beneath the serous membrane and divides into two branches that supply the superior and inferior surfaces of the organ.

Venous drainage is carried out via the homonymous cystic vein, which drains into the right lobar branch of the portal vein.

Lymphatic drainage is directed to the lymph nodes located in the porta hepatis. The organ is innervated by branches of the hepatic plexus.

Developmental anomalies and positional variants

In addition to the typical mesoperitoneal position, various anatomical variations and developmental anomalies occur:

• Intraperitoneal position: The gallbladder is covered by the peritoneum on all sides and has its own mesentery. The organ becomes excessively mobile. The main danger of this variant is the risk of torsion (volvulus), leading to impaired blood circulation and wall necrosis.
• Intrahepatic position: The gallbladder is surrounded by the liver parenchyma on all sides, making its visualization and removal extremely difficult.
• Formation anomalies: These include true duplication of the organ, as well as its dystopia (e.g., location within the thickness of the left lobe of the liver or between the layers of the falciform ligament).

Class and exam questions

What else to study on this topic

• Surgical anatomy of the cystic duct and its junction with the hepatic duct
• Technique of subserous dissection of the gallbladder during cholecystectomy
• Topography of Calot's triangle and identification of the cystic artery
• Pathogenesis of internal biliary fistula formation and gallstone ileus

Other topics in the section "Topographic Anatomy of the Abdomen"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.