Clinical case report: Laparoscopic cholecystectomy in a patient with situs inversus totalis.

Abstract

Introduction: Situs inversus is an autosomal recessive genetic condition that causes variation in the anatomical position of the abdominal viscera (1,3,9) in relation to the midline. The incidence of cholelithiasis and cholecystitis in these patients is similar to the reported in the population without this condition, however the diagnosis and surgery imply a challenge for the surgeon mainly because of changes in conventional surgical technique.

Objective: Describe a clinical case of cholelithiasis in a patient with situs inversus totalis, its management and clinical evolution, and determine the most current therapeutic surgical techniques.

Material and methods: Retrospective descriptive study presentation of a clinical case. The informed consent of the patient was requested, for review of clinical history and images that contributed to the development of the present investigation. Complete articles and review of clinical cases were reviewed.

Results: We present a case of a 42 year old patient who came into emergency area with symptoms compatible with acute cholelithiasis and a history of situs inversus totalis in which laparoscopic cholecystectomy was performed with American mirror technique.

Conclusion: Laparoscopic cholecystectomy is a safe method in patients with situs inversus totalis American mirror technique with a right-handed surgeon, as demonstrated in the present case. The diagnosis of gallbladder diseases in this type of patients is a challenge, so a thorough physical examination is a key and important part. Management is surgery, laparoscopic cholecystectomy is the Gold Standard, there is no consensus regarding the technique for trocar placement. Different techniques have been described that vary in the position and number of trocars and also in the use of ports. unique, or accessories in order to avoid bile duct injuries. It can be mentioned that for this type of surgical intervention the choice depends on the surgeon; he must feel comfortable with the placement of the trocars and triangulation. The surgeon's skill and training, preoperative imaging, and careful planning are essential pillars for the success of this surgical intervention