Anesthetic management of a patient with situs inversus posted for laparoscopic cholecystectomy

Situs inversus totalis is a rare congenital visceral malrotation anomaly that results from disturbances in establishment of left-right asymmetry. It is an autosomal recessive condition, in which organs are transposed from their normal location to the opposite side of the body and the predicted incidence is one in 10, 000 among the general population. In a patient with situs inversus totalis, not just the diagnosis of any acute abdomen pathology is difficult but equally challenging is the anesthetic management during the respective surgical procedure. We are reporting a patient who had situs inversus totalis and was operated for laparoscopic cholecystectomy under general anesthesia, and endotracheal tube as an airway conduit. Though the problems related to such patients are mainly of surgical feasibility, an anesthesiologist must be aware of the associated problems of both, situs inversus and the surgical procedures. The present case report lays an emphasis on the potential difficulties during anesthetic management and its various implications in a remote area in North East India with resource limitations. To the best of our knowledge, we report the first case from a remote are in North East India of a successful laparoscopic cholecystectomy in a patient with situs inversus totalis under general anesthesia which was uneventful.

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Case Report of Situs Inversus Totalis and Laparoscopic Cholecystectomy

International Surgery ◽

10.9738/intsurg-d-16-00109.1 ◽

2016 ◽

Vol 101 (7-8) ◽

pp. 347-351 ◽

Cited By ~ 1

Author(s):

Thomas K. Duncan ◽

Kenneth Waxman

Keyword(s):

Laparoscopic Cholecystectomy ◽

Situs Inversus ◽

Epigastric Pain ◽

Signs And Symptoms ◽

Technical Difficulty ◽

Situs Inversus Totalis ◽

Mirror Image ◽

The Body ◽

Critical View Of Safety ◽

The Right

Laparoscopic cholecystectomy (LC) in patients with situs inversus totalis (SIT) characterized by transposition of organs to the opposite side of the body can be technically challenging. A 43-year-old Hispanic woman presented with epigastric pain radiating to the chest and back, intermittently over 3 months, but worse on day of admission. During the cardiac workup, she was noted to have dextrocardia. The patient had a left-sided Murphy's sign, propagating a workup that confirmed SIT, including an ultrasound showing cholelithiasis and normal ducts. The patient underwent an LC and was found to have choledocholithiasis. An endoscopic retrograde cholangiopancreatography cleared the common bile duct of a choledocholith. LC is the gold standard for cholecystitis. It is the second most common laparoscopic procedure conducted worldwide. When SIT is encountered, feasibility and technical difficulty in diagnosis and treatment of such cases pose challenges due to contralateral transposition of the visceral organs. Difficulty is encountered when exposing the triangle of Calot/critical view of safety and especially when conducting a cholangiogram. As such, added time is usually required to conduct the procedure. Conducting an LC in a patient with SIT is feasible when performed by an experienced laparoscopic surgeon. The diagnosis and initial presenting signs and symptoms are different from the patient with a normal anatomy. The surgical skills of the surgeon are challenged, especially in the right hand–dominant individual. The mindset of the surgeon requires changing the critical thinking when conducting a mirror image dissection.

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Successful anesthetic management of laparoscopic cholecystectomy in patients with situs inversus totalis

Indian Journal of Clinical Anaesthesia ◽

10.18231/j.ijca.2019.057 ◽

2019 ◽

Vol 6 (2) ◽

pp. 304-306

Author(s):

Mustafizur Rahman ◽

◽

Deepankar Sarma ◽

Keyword(s):

Laparoscopic Cholecystectomy ◽

Situs Inversus ◽

Anesthetic Management ◽

Situs Inversus Totalis

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LAPAROSCOPIC CHOLECYSTECTOMY IN SITUS INVERSUS TOTALIS: CASE REPORTS WITH REVIEW OF LITERATURE

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i9.559 ◽

2019 ◽

Vol 3 (9) ◽

Author(s):

Bhupander Kumar Chawla ◽

Aditya Chawla

Keyword(s):

Laparoscopic Cholecystectomy ◽

Situs Inversus ◽

Case Reports ◽

Situs Inversus Totalis ◽

Cystic Artery ◽

The Body ◽

Review Of Literature ◽

Additional Time ◽

Rare Congenital Anomaly ◽

Calot’S Triangle

The first-ever known case of situs inversus in humans was reported by Fabricius in 1600[i]. The possible incidence in the region is approximated between 1:5000 and 1:200001. It can either be partial, in which the transposition gets confined to abdominal/thoracic viscera, or it may be complete, which includes both the cavities[ii]. Characterized by transposition of organs to the opposite side of the body, Situs inversus totalis is a rare congenital anomaly. Due to atypical clinical picture and due to the contralateral disposition of the visceral organs in such cases of cholelithiasis, the diagnosis, as well as the treatment, becomes a tough task for the surgeon. In such patients laparoscopic cholecystectomy is undoubtedly more demanding. Even though it is more feasible but only trained and experiences laparoscopic surgeons must perform laparoscopic cholecystectomy. The skeletonizing of the cystic duct and cystic artery in Calot's triangle is a difficult task where additional time than the normal is required for locating the gall bladder. Keywords: Cholelithiasis, laparoscopic cholecystectomy, situs inversus totalis

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Anesthetic management of a patient with situs inversus totalis undergoing coronary artery bypass grafting surgery: a case report

JA Clinical Reports ◽

10.1186/s40981-021-00431-1 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Chigusa Nakasone ◽

Masafumi Kanamoto ◽

Wataru Tatsuishi ◽

Tomonobu Abe ◽

Shigeru Saito

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Situs Inversus ◽

Anesthetic Management ◽

Artery Bypass ◽

Situs Inversus Totalis ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

Intraoperative Management

Abstract Background Anesthetic management of coronary artery bypass grafting surgery (CABG) in a dextrocardia patient with situs inversus totalis is rarely encountered and seldom reported in the literature. Case presentation A 76-year-old Japanese female patient had been diagnosed with situs inversus totalis and coronary artery disease of 3 vessels, and she subsequently underwent elective CABG. A preoperative examination showed almost normal results. ECG showed right deviation with the normal lead position. In the operating room, ECG leads were applied in reverse. Pulmonary artery catheterization was performed via the left internal jugular vein. A transesophageal echocardiography (TEE) probe was introduced without difficulty. A different angle was needed to acquire the desired views because of her atypical anatomy. Conclusion Careful perioperative evaluation, intraoperative management, and inspection of multiplane angle and probe adjustments in TEE are needed for anatomically abnormal patients.

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Robotic-assisted proximal gastrectomy using the double-flap technique for early gastric cancer with situs inversus totalis: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01262-z ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Atsushi Takeno ◽

Toru Masuzawa ◽

Shinsuke Katsuyama ◽

Kohei Murakami ◽

Kenji Kawai ◽

...

Keyword(s):

Gastric Cancer ◽

Situs Inversus ◽

Autosomal Recessive ◽

Intraoperative Complications ◽

Proximal Gastrectomy ◽

Situs Inversus Totalis ◽

Upper Body ◽

Robot Assisted ◽

Case Presentation ◽

First Case

Abstract Background The robotic system has been applied in the treatment of gastric cancer (GC), and the procedure has been found to be safe and feasible. Situs inversus totalis (SIT) is a relatively rare autosomal recessive congenital anomaly. We successfully performed robot-assisted proximal gastrectomy (RAPG) and handsewn double-flap esophagogastrostomy for GC in a patient with SIT. Case presentation A 71-year-old woman was referred to us with an asymptomatic ulcerative lesion in the upper body of the stomach. Computed tomography revealed that she had SIT. She was diagnosed with cT1bN0M0, cStageIA gastric cancer. RAPG with lymph node dissection and handsewn double-flap esophagogastrostomy was performed. Robotic surgery enabled the surgeon to perform the surgery without changing his position and experiencing any confusion resulting from the patient’s reversed anatomy. It took 448 min, and no intraoperative complications occurred. Her postoperative course was uneventful; she was discharged on postoperative day 10. The final pathologic report showed pT1b1N0M0, pStage IA. Conclusions This is the first case describing RAPG with handsewn double-flap esophagogastrostomy for a SIT patient with early GC.

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