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Laparoscopic cholecystectomy in a patient with situs inversus totalis: case report with review of literature.

ABSTRACT: Situs inversus totalis is a rare autosomal recessive disorder which can cause diagnostic confusion in a lot of clinical conditions including calculous cholecystitis due to the reversed anatomical positions of abdominal viscera. Laparoscopic cholecystectomy is much more challenging in the presence of this disorder due to loss of usual orientation. We present a case of a 43-year-old woman who was diagnosed at our centre to have calculous cholecystitis in the presence of situs inversus totalis. Laparoscopic cholecystectomy was performed safely after adjustment of the positions of the team inside the operative theatre and of the port sites. The patient tolerated the operation very well and was discharged home after 24h. On follow-up visit the patient was doing very well and completely free of symptoms.

SUBMITTER: Ali MS

PROVIDER: S-EPMC3822187 | biostudies-other | 2013

REPOSITORIES: biostudies-other

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Laparoscopic cholecystectomy in a patient with situs inversus totalis: case report with review of literature.

Ali Mohammed Sulaiman MS Attash Saad Muwafaq SM

BMJ case reports 20131007

Situs inversus totalis is a rare autosomal recessive disorder which can cause diagnostic confusion in a lot of clinical conditions including calculous cholecystitis due to the reversed anatomical positions of abdominal viscera. Laparoscopic cholecystectomy is much more challenging in the presence of this disorder due to loss of usual orientation. We present a case of a 43-year-old woman who was diagnosed at our centre to have calculous cholecystitis in the presence of situs inversus totalis. Lap ...[more]

PMID: 24105014

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Project description:Background Situs inversus totalis is a rare congenital anomaly defined by a mirror-image of thoracic and abdominal viscera. Discrete cases of situs inversus totalis and its association with gastrointestinal tumors have been reported. Here we report the first case of pancreatic-head serous cystadenoma in patient with situs inversus totalis. Case presentation A 68-year-old woman presented with an abdominal mass that appeared four months ago. She was otherwise asymptomatic and her physical examination was unremarkable. Chest X-ray revealed dextrocardia. CT scan confirmed situs inversus totalis with an irregular, clear border, heterogenous pancreatic-head mass measuring 11 cm. Laboratory studies were within the reference range and pancreatic tumor markers were normal. We performed an elective open pancreaticoduodenectomy followed by an end-to-side pancreaticojejunostomy, an end-to-side choledochojenunostomy, and a side-to-side gastrojejunostomy. The immediate postoperative course was uneventful, and she was discharged four days later without any complications. Four-month of follow-ups revealed no recurrent or relapsed disease. Discussion Although the steps of the Whipple procedure are almost the same in SIT patients. The main differences during the operation in SIT patients are the anatomical variations and how the surgeon will cope with them to avoid any mistakes. Conclusion The surgeons should improve their skills and gain control in both hands to easily adjust with the anatomic variations of situs inversus totalis and reduce the operation time and the associated risk of long operation time. Highlights • Situs inversus totalis (SIT) is a rare congenital anomaly defined by a mirror-image of thoracic and abdominal viscera.• Pancreaticoduodenectomy is more demanding and challenging to perform in patients with situs inversus totalis.• Surgeons should have a complete state of focus and take extreme care at each step during the operation.• Surgeons should improve their skills and gain control in both hands to adjust with the anatomic variations of SIT.

Project description:BackgroundSitus inversus totalis (SIT) is an uncommon disorder characterized by mirror-image anatomy, which can present unique challenges and potential vascular anomalies in surgical interventions, particularly in gastric cancer patients.AimsWe aim to delineate a rare case of gastric adenocarcinoma in a SIT patient and conduct a thorough review of the existing literature concerning surgical strategies, vascular anomalies, and outcomes observed across varied geographic locales and technological approaches.MethodsA thorough examination of a case involving a 39-year-old male SIT patient who underwent a successful distal gastrectomy with D2 lymph node dissection is presented alongside an expansive literature review. The review encompasses 47 articles, collating data on surgical approaches and vascular anomalies across 49 patients diagnosed with SIT and gastric cancer.ResultsThe patient underwent curative distal gastrectomy and Billroth II with Braun anastomosis within 95 minutes, incurring minimal intraoperative blood loss (100ml). Postoperative pathology confirmed moderately to poorly differentiated gastric adenocarcinoma (pT3N0M0), with no signs of recurrence or metastasis after 6 months of S-1 adjuvant chemotherapy. The literature review revealed vascular anomalies in approximately 20% of reported cases, accentuating its surgical significance. Noteworthy variations in surgical strategies, operative times, blood loss, and complications across different surgical modalities were observed, providing a comprehensive view into the practical management of such cases.ConclusionDespite the inherent challenges associated with SIT, various surgical techniques can be successfully applied with meticulous preoperative planning and understanding vascular anomalies. This compilation of diverse surgical experiences across numerous documented cases seeks to provide a consolidated resource for refining surgical strategies and enhancing postoperative outcomes for gastric cancer patients with SIT, underscoring the imperativeness of further research in this niche domain.

Dataset Information

Laparoscopic cholecystectomy in a patient with situs inversus totalis: case report with review of literature.

Publications

Laparoscopic cholecystectomy in a patient with situs inversus totalis: case report with review of literature.

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