scholarly journals LAPAROSCOPIC CHOLECYSTECTOMY IN SITUS INVERSUS TOTALIS – A CASE REPORT

2019 ◽  
Vol 3 (10) ◽  
Author(s):  
Dr Rohit Phadnis ◽  
Dr. U Sowmya
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Situs Inversus Totalis ◽  
Mirror Image ◽  
The Body ◽  
Left Hypochondrium ◽  
Atypical Clinical Presentation ◽  
Feasible Option ◽  
Elective Laparoscopic Cholecystectomy ◽  
Hypochondriac Pain

Background: Situs inverses totalis is a rare congenital anomaly with transposition of major organs to opposite side of the body. Due to atypical clinical presentation and due to contra lateral presence of the gall bladder, it causes clinical challenge to operate with complete reorientation of anatomy. Visual motor skills are particularly tested when it comes to lapararoscopy.  Case: A 25 year, lady presented with left hypochondriac pain and diagnosed as calculus cholecystitis with situs inverses total is. After ruling out associated anamolies patient underwent elective laparoscopic cholecystectomy.  Discussion: Around 60 cases of situs inverses total is with cholecystectomy have been reported till date. These cases cause technical and visuo-motor difficulty due to contra lateral deposition of gall bladder in left hypochondrium during laparoscopic cholecystectomy. Consumption of extra time also been reported during calot’s dissection, as it’s like operating on a mirror image.  Conclusion: Laparoscopic cholecystectomy, the gold standard treatment for cholelithiasis, is a feasible option even in cases with SIT; in the hands of good experienced, ambidextrous laparoscopic surgeons.

LAPAROSCOPIC STUDY OF CHOLECYSTECTOMY IN SITUS INVERSUS TOTALIS

2021 ◽  
pp. 67-69
Author(s):  
Rajeev Ranjan ◽  
Kamlesh Kumar Sahu ◽  
V.S. Prasad
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Situs Inversus Totalis ◽  
Mirror Image ◽  
The Body ◽  
Medical College ◽  
Left Hypochondrium ◽  
Atypical Clinical Presentation ◽  
Feasible Option ◽  
Elective Laparoscopic Cholecystectomy

BACKGROUND: Situs inverses totalis is a rare congenital anomaly with transposition of major organs to opposite side of the body. Due to atypical clinical presentation and due to contra lateral presence of the gall bladder, it causes clinical challenge to operate with complete reorientation of anatomy. Visual motor skills are particularly tested when it comes to lapararoscopy. MATERIAL AND METHODS: A 25 year, lady presented with left hypochondriac pain and diagnosed as calculus cholecystitis with situs inverses total is. After ruling out associated anamolies patient underwent elective laparoscopic cholecystectomy. Around 60 cases of situs inverses total is with cholecystectomy have been reported till date. These cases cause technical and visuo-motor difculty due to contra lateral deposition of gall bladder in left hypochondrium during laparoscopic cholecystectomy. Consumption of extra time also been reported during calot's dissection, as it's like operating on a mirror image, Department of General surgery Darbhanga medical college and Hospital Laheriasarai Darbhanga Bihar. CONCLUSION: Laparoscopic cholecystectomy, the gold standard treatment for cholelithiasis, is a feasible option even in cases with SIT; in the hands of good experienced, ambidextrous laparoscopic surgeons

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.

Situs Inversus Totalis

2001 ◽  
Vol 20 (1) ◽  
pp. 63-67 ◽  
Author(s):  
Janie Spoon
Keyword(s):  
Situs Inversus ◽  
Vena Cava ◽  
Situs Inversus Totalis ◽  
Mirror Image ◽  
The Body ◽  
Radiographic Examination ◽  
Internal Organs ◽  
Radiographic Findings ◽  
Situs Solitus ◽  
The Right

EXTERNALLY, THE HUMAN BODY appears symmetric; if a line is drawn down the middle of the body, each side appears identical. However, this is not true of the internal anatomy. For example, there is one heart, which lies in the left chest, one liver, in the right abdomen, and one stomach, in the left abdomen. The term situs refers to the position or location of an organ, specifically, the position of the atria and abdominal viscera in relation to the midline of the body.1 There are three types of situs: solitus, inversus, and ambiguous. Situs solitus refers to the normal arrangement of organs, with the right atrium, liver, gallbladder, trilobed lung, and inferior vena cava on the right side and the left atrium, stomach, spleen, bilobed lung, and descending aorta on the left side (Figures 1–3). Situs inversus totalis refers to a mirror image reversal of the normal position of the internal organs (Figures 4 and 5). 1 The incidence of situs inversus totalis is 1 in every 8,000 to 25,000 births, and the condition is most often diagnosed by radiographic examination.2Situs ambiguous, often referred to as heterotaxia, is the random arrangement of the internal organs and is associated with splenic abnormalities and congenital heart disease.3 The purpose of this column is to discuss the embryology, pathophysiology, and diagnosis of situs inversus totalis and to review a case study with radiographic findings.

Gall-Bladder Duplication - Case Report

2014 ◽  
Vol 86 (9) ◽  
Author(s):  
Bogusław Koszman
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Case Report ◽  
Gall Bladder ◽  
Anatomical Variation ◽  
Ultrasound Scanning ◽  
Persistent Symptoms ◽  
Bladder Duplication ◽  
Elective Laparoscopic Cholecystectomy ◽  
Safe Performance

AbstractGall-bladder duplication is a rare anatomical variation, which can affect safe performance of cholecystectomy and be a cause of persistent symptoms and a need for reoperation in case of accessory gall-bladder omission.A case of successfully performed elective laparoscopic cholecystectomy in a patient with duplicated gall-bladder accidentally intraoperatively disclosed is presented.The identified anomaly was classified according to the Harlaftis Classification of Multiple Gall-bladders. Attention was drawn to the uneffectivenes of ultrasound scanning in multiple gall-bladders preoperative detecting, and presence of other non-biliary anatomical variation in the same individual as well.

scholarly journals Laparoscopic Cholecystectomy in a patient with Situs Inversus Totalis

2021 ◽  
Vol 9 (1) ◽  
pp. 43-45
Author(s):  
Samail Shahjahan ◽  
Anisur Rahman
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Situs Inversus ◽  
Gall Bladder Disease ◽  
Situs Inversus Totalis ◽  
Conventional Laparoscopic Cholecystectomy ◽  
Conventional Laparoscopic ◽  
Bladder Disease ◽  
Complete Reversal ◽  
Technical Details

There are diagnostic and therapeutic challenges in cases of symptomatic gall bladder disease in patients with situs inversus totalis (SIT), where there is complete reversal of visceral topography in thorax, abdomen or both. The difficulty to treat these patients with conventional laparoscopic cholecystectomy may be more pronounced for right handed surgeon and requires modifications in working ports and their positions. We present a case of laparoscopic cholecystectomy in a patient with SIT, and describe the technical details that enable the safe conclusion of the operation. Bangladesh Crit Care J March 2021; 9(1): 43-45

scholarly journals Cholecystitis in Situs Inversus with Dextrocardia

2018 ◽  
Vol 3 (2) ◽  
pp. 87
Author(s):  
Mohammad Ali Raza Qizalbash ◽  
Rida Zahra ◽  
Adnan Adil Mithwani ◽  
Anwar Adil Mithwani ◽  
Muaaz Adil Mithwani ◽  
...  
Keyword(s):  
Congenital Anomaly ◽  
Emergency Department ◽  
Case Report ◽  
Acute Cholecystitis ◽  
Situs Inversus ◽  
Open Cholecystectomy ◽  
Situs Inversus Totalis ◽  
The Body ◽  
Rare Congenital Anomaly ◽  
Left Hypochondrium

Background: Surgical problem known as Acute Cholecystitis is very common nowadays; however it may cause trouble in diagnosing when person has situs inversus, (i.e.) viscera situated on the opposite side of the body. Our case report discusses the history and physical exam findings, images of radiograph, diagnosis, and how we dealt with cholecystitis in situs inversus with dextrocardia.Case Presentation: An eighty-six yrs. old male having pain in the upper left hypochondrium region, presented in emergency department. He was later diagnosed to have acute cholecystitis (inflammation of the gallbladder) with cholelithiasis (presence of gallstones in gallbladder) in situs inversus totalis. Patient underwent elective open cholecystectomy within 24 h. Patient recovered well and was discharged on fourth postoperative day.Conclusion: Acute cholecystitis in Situs Inversus with Dextrocardia is very rare congenital anomaly and requires great expertise in the field of surgery to operate on these patients because of the reverse anatomy of the organs.

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.

scholarly journals POSTOPERATIVE PORT-SITE PAIN AFTER GALL BLADDER RETRIEVAL FROM EPIGASTRIC VS UMBILICAL PORT IN LAPAROSCOPIC CHOLECYSTECTOMY: A RANDOMIZED CONTROLLED TRIAL

2021 ◽  
Vol 9 (09) ◽  
pp. 333-337
Author(s):  
Neel Ketu ◽  
Santosh Kumar ◽  
Prem Prakash
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Tertiary Care ◽  
Port Site ◽  
Adult Patients ◽  
P Value ◽  
Care Hospital ◽  
Duration Of Surgery ◽  
Elective Laparoscopic Cholecystectomy ◽  
Site Pain

Objective: To determine whether gall bladder (GB) retrieval from umbilical port is associated with more pain at port site as compared to GB retrieval from epigastric port in adult patients undergoing four port elective laparoscopic cholecystectomy at a tertiary care hospital. Methods: Adult patients, who were undergoing elective laparoscopic cholecystectomy during a six-month period in 2010 at our institute, were randomized to either group A (n = 60, GB retrieval through epigastric port) or group B (n = 60, GB retrieval through umbilical port). VAS for pain was assessed by a registered nurse at 1, 6, 12, 24 and 36 h after surgery. Results: The VAS for pain at umbilical port was less than epigastric port at 1, 6, 12, 24 and 36 h after surgery (5.9 ±1.1 vs. 4.1± 1.5, 4.6± 0.94 vs. 3.5± 1.05, 3.9± 0.85 vs. 2.4± 0.79, 3.05± 0.87 vs. 2.15± 0.87, respectively) and the difference was statistically significant (p-value < 0.001). Multiple linear regression was done for port site pain at 24 h and the VAS at umblical port was less than epigastric port with VAS difference of 0.9 after adjusting for age, sex, duration of surgery and additional analgesia use (r 2 =0.253, p-value < 0.001). Conclusion: Gall bladder retrieval from umbilical port is associated with lower port site pain than GB retrieval from epigastric port in patients undergoing elective laparoscopic cholecystectomy. We recommend umbilical port for gall bladder retrieval.

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

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