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. 2014;5(11):821-3.
doi: 10.1016/j.ijscr.2014.08.004. Epub 2014 Aug 26.

Management of a patient with situs inversus totalis with acute cholecystitis and common bile duct stones: A case report

Ashwanth Reddy  1 , Surendran Paramasivam  2 , Naveen Alexander  2 , Abhilash  2 , Vigneshwar Ravisankar  2 , Manoj Thillai  2
Affiliations

Management of a patient with situs inversus totalis with acute cholecystitis and common bile duct stones: A case report

Ashwanth Reddy et al. Int J Surg Case Rep. 2014.

Abstract

Introduction: The incidence of situs inversus thought to be in the range of 1:10,000-1:20,000 according to Mayo et al.

Presentation of case: A forty-five year-old lady presented with pain in the left hypochondrium and was diagnosed to have acute cholecystitis with choledocholithiasis in situs inversus totalis. Patient underwent endoscopic sphincterotomy and common bile duct stone extraction in view of choledocholithiasis and after common bile duct cannulation patient taken up for elective laparoscopic cholecystectomy (LC) within 24h.

Discussion: The most challenging factor for performing surgery in a patient with situs inversus is dealing with the mirror image anatomy. The first laparoscopic cholecystectomy in situs inversus was reported by Campos et al. in 1991. Since then, 50 other cases have been reported in literature making a point that laparoscopic procedure is not contraindicated.

Conclusion: Acute cholecystitis with choledocholithiasis is extremely rare and requires expert intervention from both the endoscopist and the laparoscopic surgeons because of the reverse anatomy and the fact that both are attuned to the constant practice of the procedures in normal anatomy.

Keywords: Laparoscopic Cholecystectomy in Situs inversus totalis.

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Figures

Fig. 1
Fig. 1
X-ray chest.
Fig. 2
Fig. 2
CECT whole abdomen.
Fig. 3
Fig. 3
Sphincterotomy.
Fig. 4
Fig. 4
Specimen after surgery showing gallbladder and calculi.
See this image and copyright information in PMC

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