Three-port laparoscopic cholecystectomy in situs inversus totalis: A case report

Abstract

Rationale: Situs inversus totalis (SIT), a congenital anomaly characterized by the mirror-image inversion of thoracic and abdominal viscera, necessitates a cautious approach in the diagnosis and treatment of patients presenting with symptomatic cholelithiasis. Laparoscopic cholecystectomy, the preferred procedure for gallbladder removal in SIT patients, achieves favorable outcomes through thorough preoperative planning, a deep understanding of anatomy, and intraoperative adaptability.

Patient concerns: Herein, we present the case of a 51-year-old female patient in SIT who underwent a laparoscopic cholecystectomy without complications due to choledocholithiasis and gallbladder stones.

Diagnosis: Gallbladder stone; SIT.

Interventions: laparoscopic cholecystectomy.

Outcomes: No complications such as bleeding or bile leakage (after LC) was detected. The patient was discharged after 2 days and recovered well after 1-year follow-up.

Lessons: Thorough preoperative surgical planning, a deep understanding of anatomy, and the ability to adapt flexibly during surgery are key to the success of the operation.

Keywords: anatomical variations; laparoscopic cholecystectomy; situs inversus totalis.

Figure 1.

(A) Abdominal ultrasound image of the left upper quadrant showing a gallbladder with multiple stones (yellow arrow) (B) Chest X-ray demonstrated dextrocardia.

Figure 2.

Magnetic resonance cholangiopancreatography (MRCP) scan confirmed the diagnosis of choledocholithiasis and gallbladder stones.

Figure 3.

Adapted surgical positioning and trocar site placement for laparoscopic cholecystectomy in the patient with SIT. SIT = situs inversus totalis.

Figure 4.

Laparoscopic image of intraoperative findings.

Figure 5.

Intraoperative view of the cystic artery and bile duct.