The gallbladder is located between segments IV and V of the liver in a bare area, not covered by the visceral peritoneum. An 81-year-old woman presented with chronic abdominal pain in the epigastrium and right hypochondrium, associated with weight loss and an abdominal tumor. A CT scan revealed a polycystic liver with a massive hepatic cyst in the right lobe (fig. 1).

Figure 1.

Abdominal computed tomography scan showing voluminous hepatic cysts.

Surgical exploration identified the gallbladder surrounded by the thick serosal layer of a hepatic cyst (fig. 2).

Figure 2.

Subcapsular position of the gallbladder.

The atypical location of the gallbladder alerted the surgical team to the possibility of a biliary tract abnormality, which was ruled out after performing an intraoperative cholangiography. Polycystic liver is estimated to occur in approximately 5% of the population. Exaggerated growth of the cysts can cause abdominal pain and distension, dyspepsia, early satiety, dyspnea, and a visible or palpable abdominal tumor. The cysts do not usually reach the biliary or vascular structures, but if that occurs, it can compress the biliary tract and cause jaundice in up to 9% of the patients.