Elderly age and female gender remain the most well-documented risk factors for gallbladder herniation (at any location). It is postulated that reduced peritoneal fat, a smaller liver, weakened anterior abdominal wall musculature and an increasingly ptotic gallbladder contributed by elongation of attached mesentery are all contributing factors to this rare condition [1, 2]. Apart from the more commonly reported para- stomal, incisional and lesser sac gallbladder hernia, there has been the occasional standout report of exceedingly rare locations for a herniated gallbladder. Tajti et.al [5] and Rodrigues et.al [6]. report on, to date, the only encounters of gallbladder herniation through the inguinal and femoral canals respectively. Both patients were treated with an open cholecystectomy and subsequent hernia repair. Donati et.al describes the only case of gallbladder herniation through a Spigelian hernia [7]. This patient was an 84-year-old lady who presented with right iliac fossa pain and a palpable swelling in the para- rectal location. CT revealed a ptotic gallbladder with right sided intra-abdominal peritonitis and free fluid accumulation adjacent to a Spigelian hernia sac. Surgical exploration found a ptotic and necrotic gallbladder rotated on its cystic duct axis by >180^o. She was treated with a cholecystectomy and primary repair of Spigelian hernia. Carragher et. al. describes an interesting case of subcutaneous right upper quadrant gallbladder herniation with spontaneous discharge of pus through a cholecystocutaneous fistula [8]. Finally, Schiffman et. al. reports on an intercostal gallbladder herniation in a patient with previous thoracotomy and right lower lobectomy for lung carcinoma. This condition was attributed to the vacuum that the lower lobectomy left, combined with an extremely lax diaphragm and chest wall [9].

To our knowledge, there have only been 4 reports to date of gallbladder herniation through ventral wall defects [10-13]. All 4 patients were symptomatic at presentation and underwent cholecystectomy. Goldman et. al. describes a case of gallbladder herniation through the epigastric linea alba. Intra-operatively, it was found that the cystic duct and artery had been compressed by the hernial ring, resulting in both obstruction and ischemia [10]. Paolino et. al. reports on a unique case of gallbladder herniation being complicated by Mirizzi’s syndrome. This 85-year-old patient presented with right-sided abdominal pain. CT confirmed the presence of a herniated gallbladder through the anterior abdominal wall, combined with a 1.7cm infundibular stone causing dilatation of the common bile duct. Laparoscopic cholecystectomy was performed uneventfully, and the defect primarily repaired with absorbable sutures [13]. Paolino et. al. and El-Bakush et. al. are the only authors to report on a laparoscopic technique for cholecystectomy in the context of gallbladder herniation through ventral herniae [12, 13]. Both patients recovered well with no complications.

Our study is the first to report a ventral gallbladder herniation through the layers of the right anterolateral abdominal wall. In addition, we are the first to report this as an incidental finding in an asymptomatic patient who was ultimately treated conservatively. Complications from gallbladder herniation include incarceration, cholecystitis, gallbladder volvulus and gallbladder ischemia/gangrene [10, 14, 15]. We can, however, expect an increasing number of asymptomatic and uncomplicated gallbladder herniation to be incidentally picked up on the myriad of scans that have now become commonplace for a good majority of our patients. In the absence of symptoms or complications, conservative management is a viable option.