scholarly journals Laparoscopic cholecystectomy in situs inversus totalis: case report

2019 ◽  
Vol 6 (6) ◽  
pp. 2210
Author(s):  
Sreedhar Rao Kota ◽  
Abhilash Gundala ◽  
Srikanth Sirikonda ◽  
Jayachandra Reddy Metta ◽  
Mayur Kumar Jinde
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Situs Inversus ◽  
Situs Inversus Totalis ◽  
Mirror Image ◽  
Uneventful Recovery ◽  
Rare Entity ◽  
Review Of Literature ◽  
Technical Approach ◽  
Set Up ◽  
Calculous Cholecystitis

Laparoscopic cholecystectomy is one of the commonest surgical procedures carried out in the world today. Occasionally, few undiagnosed situs inversus patients present with calculous cholecystitis. One such case is being discussed here on how the diagnosis was made and focuses on the technical approach to the operation along with review of literature. A 52 year old female presented to our department with right hypochondrial pain which was diagnosed as choledocholithiasis and calculous cholecystitis with situs inversus totalis following clinical and radiological evaluation. Patient underwent ERCP and CBD, PD stenting, following which laparoscopic cholecystectomy was performed and the patient made uneventful recovery. Situs inversus with calculous cholecystitis is a rare entity. The surgeon must appreciate that care should be taken to set up the operating theatre in the mirror image of the normal set up for cholecystectomy. Surgerons must also modify their technique to adapt mirror image anatomy. 

scholarly journals Laparoscopic Cholecystectomy for Severe Acute Cholecystitis in a Patient with Situs Inversus Totalis and Posterior Cystic Artery

2008 ◽  
Vol 2008 ◽  
pp. 1-3 ◽  
Author(s):  
Theodoros E. Pavlidis ◽  
Kyriakos Psarras ◽  
Apostolos Triantafyllou ◽  
Georgios N. Marakis ◽  
Athanasios K. Sakantamis
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Situs Inversus ◽  
Anatomical Variations ◽  
Situs Inversus Totalis ◽  
Mirror Image ◽  
Cystic Artery ◽  
Quadrant Pain ◽  
Abdominal Organs ◽  
Thoracic And Abdominal

Situs inversus totalis is an inherited condition characterized by a mirror-image transposition of thoracic and abdominal organs. It often coexists with other anatomical variations. Transposition of the organs imposes special demands on the diagnostic and surgical skills of the surgeon. We report a case of a 34-year-old female patient presented with left upper quadrant pain, signs of acute abdomen, and unknown situs inversus totalis. Severe acute cholecystitis was diagnosed, and an uneventful laparoscopic cholecystectomy was performed. A posterior cystic artery was identified and ligated. Laparoscopic cholecystectomy is feasible in patients with severe acute calculus cholecystitis and situs inversus totalis; however, the surgeon should be alert of possible anatomic variations.

Case Report of Situs Inversus Totalis and Laparoscopic Cholecystectomy

2016 ◽  
Vol 101 (7-8) ◽  
pp. 347-351 ◽  
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.

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

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

scholarly journals Laparoscopic cholecystectomy in situs inversus totalis: A case report

2021 ◽  
Vol 38 (2) ◽  
pp. 183-188
Author(s):  
Radomir Gelevski ◽  
Gjorgji Jota ◽  
Lazar Todorović ◽  
Gjorgji Trajkovski ◽  
Vladimir Joksimović ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Situs Inversus ◽  
Epigastric Pain ◽  
Genetic Defect ◽  
Operating Time ◽  
Situs Inversus Totalis ◽  
Mirror Image ◽  
Digestive Tube ◽  
Left Hand ◽  
Standard Position

Situs inversus totalis represents a rare autosomal recessive morphological anomaly of the internal viscera, equally affecting both genders. The genetic defect occurs in the 2nd week of embryonic life, when a 270-degree clockwise rotation of the primitive digestive tube occurs. The incidence of calculosis of gallbladder in patients with situs inversus is the same as in the general population. A 61-year-old female patient with a history of four episodes of colicky, left hypochondrium and epigastric pain, without fever and jaundice, was admitted for elective laparoscopic cholecystectomy. CT of abdomen confirmed situs inversus totalis that was previously known to the patient. The patient was positioned in supine position and a mirror image configuration of the operating room was obtained, with surgeon and scrub nurse on the right side and assistant on the left side of the patient. Four trocars were introduced mirroring the standard position of the 5 mm trocars. During the dissection, second assistant was introduced for the laparoscope, due to the surgeon's limited motor skills in his left hand for delicate dissection, rendering him inapt to perform precise and safe dissection. The total operating time amounted to 110 minutes, which is three times longer than the standard operating time at our institution. The most critical point of the operation in constellation of situs inversus totalis is applying the clips, which requires precision and strength in the same moment. In the available literature, 40 open cholecystectomies before introduction of laparoscopy and 92 laparoscopic cholecystectomies were reported. To our knowledge, this is the first and the only reported laparoscopic cholecystectomy for situs inversus in North Macedonia.

scholarly journals Laparoscopic cholecystectomy in situs inversus totalis: is it safe?

2010 ◽  
Vol 92 (5) ◽  
pp. e30-e32 ◽  
Author(s):  
TC Hall ◽  
J Barandiaran ◽  
EP Perry
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Surgical Technique ◽  
Genetic Predisposition ◽  
Situs Inversus ◽  
Situs Inversus Totalis ◽  
Mirror Image ◽  
Therapeutic Management ◽  
Review Of The Literature ◽  
Symptomatic Cholelithiasis

Situs inversus totalis (SIT) is a rare defect of genetic predisposition. It may cause difficulties in the diagnostic and therapeutic management of abdominal pathology due to the mirror-image anatomy. We report the management of a case of symptomatic cholelithiasis with emphasis on its surgical technique combined with a review of the literature.

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