The incidental discovery of a Phrygian cap of the gallbladder during a Whipple's procedure for pancreatic head cancer in a 48-year-old female presents a unique and noteworthy finding. The Phrygian cap anomaly, characterised by a fold or hooding of the gallbladder fundus over the body, is a rare congenital variation often detected incidentally during imaging or surgical procedures [8]. In this case, the discovery of the Phrygian cap adds a layer of complexity to an already intricate surgical intervention for pancreatic head cancer. The presence of a Phrygian cap may alter the usual anatomical landmarks, requiring adaptability and precision to avoid accidental injury to the gallbladder or bile ducts [5].

In the case of a 65-year-old female reported by Kulkarni et al., the Phrygian cap of the gallbladder was discovered during an emergency exploratory laparotomy undertaken for a sealed-off perforation at the pyloric part of the stomach [9]. In our case of a 48-year-old female, it was incidentally noted during a Whipple's procedure performed for pancreatic head cancer. Both cases involve the identification of a gallbladder anomaly during surgical intervention for other conditions. However, the approach to managing the gallbladder anomaly differs significantly between the two cases [9]. In our case, where the patient underwent a Whipple's procedure, the Phrygian cap was meticulously removed along with the primary focus of the surgery, namely pancreatic head cancer. This approach aligns with the principle of comprehensive surgical intervention aimed at addressing all identifiable pathologies within the operative field.

Conversely, in the case reported by Kulkarni et al., the anomaly was asymptomatic, and the operating surgeons opted against further dissection, likely due to the absence of clinical indications necessitating intervention [9]. Instead, the surgery addressed the primary pathology, namely the sealed-off perforation at the pyloric part of the stomach, through Graham's patch repair. This decision reflects a more conservative approach, prioritising the management of symptomatic conditions while avoiding unnecessary interventions for asymptomatic anomalies.

In the case of a 41-year-old female patient reported by Ogut et al., presenting with symptoms of acute cholecystitis, including severe upper right abdominal pain, nausea, vomiting, and fever [10], despite a history of peptic ulcer disease, diagnostic imaging revealed gallbladder duplication with stones. Emergency open cholecystectomy was performed due to the complexity of the case, revealing two gallbladders with corresponding cystic ducts and an anomaly involving the right hepatic duct [10]. Successful removal of both gallbladders was achieved, ensuring patient safety and recovery. Follow-up confirmed a favourable outcome. This case underscores the significance of thorough exploration and open surgery in managing anatomical variations like gallbladder duplication, promoting optimal patient outcomes [10].

The incidental finding of a Phrygian cap of the gallbladder in the case of the 81-year-old male undergoing right hemicolectomy and liver resection for adenocarcinoma with liver metastasis presents an interesting comparison to a similar finding in a younger patient undergoing Whipple's procedure or pancreaticoduodenectomy, as reported in this case of a 48-year-old female [11]. In both cases, the Phrygian cap anomaly of the gallbladder was noted incidentally during surgical procedures aimed at addressing primary malignancies in other organs. The advanced age of the patient, in the case of the 81-year-old male reported by van Kamp et al., adds complexity due to the presence of multiple comorbidities and the need for simultaneous surgical interventions for colon cancer and liver metastasis [11]. The decision to perform cholecystectomy to facilitate liver resection highlights the importance of thorough perioperative evaluation and strategic planning to optimise surgical outcomes, especially in elderly patients with significant medical history. Both cases highlight the importance of recognising and addressing incidental anatomical variations, such as the Phrygian cap, during surgical interventions to optimise patient care and surgical outcomes.

In the case of a 53-year-old female reported by Al-Ashqar et al., she initially presented with a three-month history of right upper quadrant abdominal pain radiating to her back, accompanied by nausea and unintentional weight loss [12]. Diagnostic laparoscopy confirmed the presence of a folded fibrous cap on the gallbladder fundus, consistent with a Phrygian cap, alongside microscopic evidence of chronic cholecystitis. The patient underwent laparoscopic cholecystectomy, leading to complete resolution of symptoms. In our case of the 48-year-old female during a Whipple's procedure, incidental Phrygian cap discovery was observed. In contrast, in the 53-year-old female case reported by Al-Ashqar et al., laparoscopic cholecystectomy following diagnostic laparoscopy confirmed the presence of a Phrygian cap [12]. Both these cases show the importance of proper diagnosis and surgery in managing incidental findings, which helps manage the patient's condition and treatment properly.