Laparoscopic cholecystectomy in Situs inversus totalis: a case report
Authors:
Background: Situs inversus totalis (SIT) is a rare congenital condition characterized by the mirror-image reversal of the thoracic and abdominal organs. SIT presents significant challenges during surgical procedures that require anatomical familiarity and dexterity, such as laparoscopic cholecystectomy. Case Presentation: A 73-year-old woman with SIT presented with a 2-day history of left-sided hypochondrial colicky abdominal pain aggravated by food intake and associated with nausea. Physical examination revealed a positive Murphy’s sign in the left hypochondrium. Laboratory tests showed leukocytosis and elevated liver enzymes. Imaging (See Figures 1-4) confirmed acute cholecystitis with the gallbladder in the left upper quadrant. The patient was scheduled for laparoscopic cholecystectomy. Preoperative planning involved detailed imaging and coordination with the anesthesiology team. The surgical technique was adapted for SIT, including specific patient positioning and a mirror-image approach. The gallbladder was successfully removed, with careful dissection of the cystic duct and artery. Postoperative management included non-steroidal anti-inflammatory drugs, opioids, and monitoring. The patient’s recovery was uneventful, and she was discharged on the third postoperative day with follow-up instructions. The care plan included pain management, regular monitoring, early mobilization, diet progression, and scheduled outpatient visits. Conclusion: Laparoscopic cholecystectomy in patients with SIT requires careful preoperative planning, skilled surgical techniques, and effective team communication. Despite these challenges, successful outcomes are possible with meticulous attention to detail and adaptation to the reversed anatomy.
Keywords: Situs inversus totalis, laparoscopic cholecystectomy, reversed anatomy, acute cholecystitis, surgical technique adaptation.
Authors
Correspondence to:
Meshaal EOSS Alenezi, Assistant Registrar, Department of General Surgery, Al Jahra Hospital, Al Jahra, Kuwait drmeshaal95@gmail.com
Publication history:
Accepted 16 Aug 2024
Published online 17 Aug 2024
MEA, MA, AlRuwaished M, Ahmed A. Laparoscopic cholecystectomy in Situs inversus totalis: a case report. EJMCR. Online First: 21 Aug, 2024. doi:
10.24911/ejmcr.173-1718395147
MEA, MA, AlRuwaished M, Ahmed A. Laparoscopic cholecystectomy in Situs inversus totalis: a case report. https://www.ejmcr.com/?mno=302657678 [Access: September 01, 2024]. doi:
10.24911/ejmcr.173-1718395147
MEA, MA, AlRuwaished M, Ahmed A. Laparoscopic cholecystectomy in Situs inversus totalis: a case report. EJMCR. Online First: 21 Aug, 2024. doi:
10.24911/ejmcr.173-1718395147
MEA, MA, AlRuwaished M, Ahmed A. Laparoscopic cholecystectomy in Situs inversus totalis: a case report. EJMCR, [cited September 01, 2024]; Online First: 21 Aug, 2024. doi:
10.24911/ejmcr.173-1718395147
, M. E. A., , . M. A., AlRuwaished, . M. & Ahmed, . A. (2024) Laparoscopic cholecystectomy in Situs inversus totalis: a case report. EJMCR, Online First: 21 Aug, 2024. doi:
10.24911/ejmcr.173-1718395147
, Meshaal EOSS Alenezi, Mohammad AlJasmi, Mohammed AlRuwaished, and Atef Ahmed. 2024. Laparoscopic cholecystectomy in Situs inversus totalis: a case report. European Journal of Medical Case Reports, Online First: 21 Aug, 2024. doi:
10.24911/ejmcr.173-1718395147
, Meshaal EOSS Alenezi, Mohammad AlJasmi, Mohammed AlRuwaished, and Atef Ahmed. "Laparoscopic cholecystectomy in Situs inversus totalis: a case report." European Journal of Medical Case Reports Online First: 21 Aug, 2024. doi:
10.24911/ejmcr.173-1718395147
, Meshaal EOSS Alenezi, Mohammad AlJasmi, Mohammed AlRuwaished, and Atef Ahmed. "Laparoscopic cholecystectomy in Situs inversus totalis: a case report." European Journal of Medical Case Reports Online First: 21 Aug, 2024. Web. 01 Sep 2024 doi:
10.24911/ejmcr.173-1718395147
, M. E. A., , . M. A., AlRuwaished, . M. & Ahmed, . A. (2024) Laparoscopic cholecystectomy in Situs inversus totalis: a case report. European Journal of Medical Case Reports, Online First: 21 Aug, 2024. doi:
10.24911/ejmcr.173-1718395147