Background <p>The sigmoid gallbladder is a rare anatomic variant characterized by an S-shaped curve in its structure, often stemming from abnormal embryonic development during gestation. This anomaly complicates surgical procedures like cholecystectomy, primarily due to its convoluted shape and potential for misdiagnosis. Case studies indicate that preoperative imaging techniques, including ultrasound and MRCP, are essential for accurate diagnosis and preventing bile duct injuries. Although sigmoid gallbladders are typically asymptomatic unless associated with gallstones, thorough imaging and surgical techniques are crucial for successful management, as anatomic variations might be present and would potentially lead to intraoperative difficulties and therefore complications.</p> Case presentation <p>This case highlights a 38-year-old female with symptoms of cholelithiasis who underwent a laparoscopic cholecystectomy at Oda Hulle General Hospital in Ethiopia. The surgery was complicated by an S-shaped gallbladder anatomy that obscured necessary structures, necessitating careful dissection to prevent bile duct injury. Postoperative recovery was uneventful, and the patient was discharged after two days.</p> Conclusion <p>This case underscores the impact of anatomical variations on gallstone management and the critical need for preoperative imaging, like MRCP, to navigate such complexities. In resource-limited settings, adaptability during surgery and an understanding of biliary anomalies are essential for minimizing complications. The case serves as a reminder of the need for improved anatomical awareness and documentation of gallbladder anatomic variations, which could enhance surgical practices globally.</p>