Floating gallbladder in exomphalos minor an exceptional condition that should be considered, a case report

BACKGROUND: The exomphalos minor or small omphalocele is a defect of the abdominal wall smaller than 5 cm, located in the umbilical cord. It presents a sac containing intra-abdominal organs, mainly the small intestine. The main surgical objective is to repair the defected wall, preserving the intra-abdominal structures inside the sac. A floating gallbladder is unusual in this pathology; however, it must be removed when that occurs due to the risk of torsion, inflammation, and volvulus. PRESENTATION OF CASE: We present the case of a 7-day-old patient who comes to the emergency room with an abdominal mass. The physical examination shows minor exomphalos with local signs of inflammation. Genetic, chromosomal, and imaging studies are solicited. The abdominal ultrasonography report shows the absence of the gallbladder in the liver. The patient requires surgical correction of abdominal wall defect. The gallbladder is found inside the sac of defect that does not have a hepatic fixation; a cholecystectomy is performed. The patient presents a satisfactory postoperative evolution and is discharged. CONCLUSIONS: The exomphalos minor is a malformation of the abdominal wall. It needs surgical treatment; this must be done carefully, preserving the intra-abdominal organs inside the sac as much as possible. The gallbladder without hepatic fixation, elongated meso, or suspended by its pedicle is unusual in pediatric age, and they present a higher risk of torsion, inflammation, and necrosis. For this reason, cholecystectomy is indicated. A minor exomphalos has a better prognosis when the defect is small. It is not associated with malformations or associated structural alterations.