Acute Cholecystitis in a Patient With Situs Inversus Totalis: An Unexpected Finding

Abstract

Situs inversus totalis (SIT) has an incidence in the general population of 1/10,000, with a female-male ratio of 1:1.5 without racial predilection. Clinically, SIT by itself tends to be asymptomatic; however, when it is associated with other conditions such as cholecystitis or appendicitis, the diagnosis may represent a challenge due to the reversed anatomical location of symptoms.

This article presents a case of a 46-year-old female who arrived at the emergency department due to one week of non-bilious vomiting and colicky abdominal pain located in the left hypochondrium; therefore, abdominal ultrasonography was performed, showing transposition of abdominal organs associated with cholelithiasis plus acute cholecystitis. As a result, the patient was scheduled for laparoscopic cholecystectomy, resulting in an appropriate post-surgical evolution, for which discharge was given with a general surgery control appointment.

Laparoscopic cholecystectomy in patients with SIT represents a challenge due to the technical complexity derived from the transposition of the abdominal organs; therefore, the surgeon is forced to perform the procedure by placing three trocars with a specular approach plus the umbilical trocar.