Laparoscopic cholecystectomy in situs inversus totalis: Case report with review of techniques

Highlights

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  SIT is a rare congenital anatomy with mirror image transposition of the viscera.

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  The underlying anatomical variation poses a challenge in the diagnosis and management of cholelithiasis In patient with SIT.

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  Laparoscopic cholecystectomy can be safely performed in these cases.

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  It is considered technically challenging procedure and often requires alteration in the technique compared to the conventional laparoscopic cholecystectomy.

Abstract

Introduction

Situs inversus totalis (SIT) is a congenital disorder in which the visceral organs are mirrored from their normal anatomical position. Diagnosis and management of cholelithiasis in patient with SIT poses a challenge due to the underlying anatomical variation.

Presentation of case

We report a case of a 40-year-old male patient who presented with an intermittent history of epigastric and left upper quadrant pain for one month. Clinical assessment and radiological investigations confirmed the presence of cholelithiasis with evidence of SIT. The patient underwent elective laparoscopic cholecystectomy with no complication and he had an uneventful recovery. Various intraoperative modification has been made to overcome the technical difficulties encountered due to the underlying anatomical variation.

Discussion

Since the first successful laparoscopic cholecystectomy in patient with SIT performed in 1991, 85 cases have been reporsted in the literature. Surgeons managed to overcome the technical difficulties by adopting various modification in the techniques compared to the conventional laparoscopic cholecystectomy.

Conclusion

The anatomical variation in SIT can influence the localization of symptoms in patient with cholelithiasis leading to a delay in diagnosis and management. Laparoscopic cholecystectomy can be safely performed in these cases. However, it is considered technically challenging procedure and often requires alteration in the technique.