Laparoscopic cholecystectomy in a patient with empyema of the gallbladder and situs inversus

Delayed diagnosis of abdominal pain in patient with situs inversus totalis in emergency department: A case report

RATIONALE

Abdominal pain is one of the most common complaints for patients in emergency department. It's difficult to make an accurate diagnosis by emergency physician in time, especially in patients with situs inversus totalis.

PATIENT CONCERNS

A patient with acute exacerbation of chronic left upper quadrant abdominal pain.DIAGNOSES:: cholangiolithiasis with situs inversus totalis.

INTERVENTIONS

laparoscopic cholecystectomy and laparoscopic exploration of common bile duct.

OUTCOMES

The patient had an uneventful recovery.

LESSONS

High suspicion and adequate evaluation are important for diagnosis in patients with abdominal pain and situs inversus totalis in emergency department, and physical examination, electrocardiogrphy and radiological investigations are necessary.

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

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.

Laparoscopic cholecystectomy in situs inversus totalis: Feasibility and review of literature

INTRODUCTION

Situs inversus totalis is a rare anomaly characterized by transposition of organs to the opposite site of the body. Laparoscopic cholecystectomy in those patients is technically more demanding and needs reorientation of visual-motor skills to left upper quadrant.

PRESENTATION OF CASE

Herein, we report a 10 year old boy presented with left hypochondrium and epigastric pain 2 months duration. The patient had not been diagnosed as situs inversus totalis before. The patient exhibit a left sided "Murphy's sign". Diagnosis of situs inversus totalis was confirmed with ultrasound, computerized tomography (CT) and magnetic resonant image (MRI) with presence of multiple gall bladder stones with no intra or extrabiliary duct dilatation. The patient underwent laparoscopic cholecystectomy for cholelithiasis.

DISCUSSION

Feasibility and technical difficulty in diagnosis and treatment of such case pose challenge problem due to the contra lateral disposition of the viscera. Difficulty is encountered in skelatonizing the structures in Calot's triangle, which consume extra time than normally located gall bladder. A summary of additional 50 similar cases reported up to date in the medical literature is also presented.

CONCLUSION

Laparoscopic cholecystectomy is feasible and should be done in situs inversus totalis by experienced laparoscopic surgeon, as changes in anatomical disposition of organ not only influence the localization of symptoms and signs arising from a diseased organ but also imposes special demands on the diagnosis and surgical skills of the surgeon.

Single incision laparoscopic cholecystectomy (SILS) for a patient with situs inversus totalis

Laparoscopic surgery has become the gold standard for the surgical treatment of benign disorders of bile ducts, for example, symptomatic cholelithiasis. Nowadays, laparoscopic surgery is becoming less invasive by means of the advanced technologic capabilities. In this article, the authors present a 65-year-old patient with situs inversus totalis who was examined because of abdominal pain and dyspeptic symptoms. Ultrasonography and tomography revealed cholecystitis with gallstones (calculous cholecystitis), besides, it was observed that the liver and the gall bladder were on the left side and the heart, the stomach and the spleen were located on the right side of the patient. The patient was performed single incision laparoscopic cholecystectomy. The patient was discharged on the postoperative day 1. In the present article, the authors described how easily the single incision laparoscopic cholecystectomy could resolve the technical difficulties encountered in the patients with situs inversus totalis during the conventional laparoscopic surgery.

Cholecystectomy in situs inversus totalis: a laparoscopic approach

PURPOSE

To report and describe a safe approach to laparoscopic cholecystectomy in patients with situs inversus totalis.

METHODS

We present the case of a 61-year-old male who was diagnosed with gallstones and situs inversus totalis during work-up for epigastric pain. Laparoscopic cholecystectomy was performed in mirror-image to the standard approach, with the surgeon standing on the patient's right side. In order to maintain orientation and safety during the operation, anatomical structures were spatially related to each other in a "medial" and "lateral" manner, which are preserved in situs inversus; rather than "left" and "right" which are reversed.

RESULTS

The duration of the operation was 85 minutes, which is slightly longer than our standard laparoscopic cholecystectomy. Nonetheless, the patient was discharged on the morning following surgery, which is comparable to other patients undergoing laparoscopic cholecystectomy. He was seen in follow-up on postoperative day 14 and was doing very well. There were no postoperative complications.

CONCLUSION

Laparoscopic cholecystectomy can be performed safely in patients with situs inversus totalis. Careful attention to unfamiliar anatomic relationships is important. Approaching the anatomy in terms of medial and lateral structures, a relationship that is preserved, is helpful to complete the procedure safely.

Laparoscopic cholecystectomy in a patient with situs inversus totalis

Currently, laparoscopic cholecystectomy is an undoubtfully optimal treatment of cholelithiasis. What about performing this procedure on a patient with situs inversus totalis and what are the difficulties of this operation for a right-handed surgeon We presented a 35-year-old man with unknown situs inversus totalis who was admitted with epigastric pain and digestive problems. Ultrasonography and computed tomography of the abdomen confirmed the diagnosis of a gallstone. Besides, the liver and gallbladder were on the left side and the spleen was on the right. All systems were left-right reversal as mirror image in all diagnostic studies. Laparoscopic cholecystectomy was safely performed, despite of difficulties of situs inversus. The patient was discharged on postoperative day 1. It should be considered that existence of other anomalies may easily cause uninvited injuries. In the patients with situs inversus, laparoscopic cholecystectomy can be safely managed by an experienced surgeon through laparoscopy, and also hepatobiliary surgery.

Laparoscopic cholecystectomy for acute cholecystitis in patient with situs viscerum inversus

Situs viscerum inversus is a rare condition with perfect mirror image organs position. Despite the well-described existence of this condition, the implication for the treating of emergency pathology can be important following to the difficult interpretation of signs and symptoms. We report a case of acute cholecystitis in patients with known dextrocardia who was successfully treated by laparoscopic cholecystectomy. The diagnostic problems and surgical technique pitfalls are discussed.

Laparoscopic cholecystectomy in situs inversus totalis with “inferior” cystic artery: A case report

A 76-year-old man with known situs inversus totalis presented with left-sided discomfort. Abdominal ultrasonography and CT scan confirmed the diagnosis of a gallstone, as well as, situs inversus; the liver and gallbladder on the left side and the spleen on the right. The biliary system was thought to be left-right reversal, mirror image in the view of drip infusion cholangiogram and MRI. Laparoscopic cholecy stectomy was safely performed, despite of unexpected aberrant cystic artery running inferior to cystic duct of situs inversus. Laparoscopic surgeon should be careful for view of reversed relationships and also existence of other anomalies.

The management of esophageal cancer with situs inversus totalis by simultaneous hand-assisted laparoscopic gastric mobilization and thoracoscopic esophagectomy

Situs inversus is a rare disorder. We present a case of esophageal cancer with situs inversus totalis, which was successfully managed by laparoscopic gastric mobilization and thoracoscopic esophagectomy. A 57-year-old man presented to our hospital with intermittent epigastric and retrosternal pains. X-ray and computed tomography demonstrated situs inversus totalis. Upper gastrointestinal endoscopy and barium swallow showed esophageal cancer of the lower thoracic esophagus. After neoadjuvant chemotherapy, he underwent surgical intervention. Under general anesthesia, laparoscopic gastric mobilization using hand-assisted laparoscopic surgery technique was performed. The locations of the port sites were all the mirror image of the regular fashion, and the right hand of the surgeon was inserted into the peritoneal cavity. Reconstruction of the digestive tract using a gastric tube via the retrosternal route was then achieved. Finally, thoracoscopic esophagectomy with the patient in the right decubitus position was successfully completed. Postoperative recovery was uneventful.

Laparoscopic exploration of the common bile duct in a patient with situs inversus totalis

Situs inversus totalis (SIT) is a rare anomaly that can present technical difficulties during laparoscopic surgery. We report the first case of a combination of SIT and choledocholithiasis in a patient who was treated successfully with a laparoscopic exploration of the common bile duct (CBD). The chest x-ray showed a right-sided heart. An abdominal ultrasound and computerized tomography scan diagnosed the CBD and gallbladder stones as well as the SIT, with the liver and gallbladder on the left side, and the spleen on the right. The surgical techniques were modified in a mirror image fashion in order to provide access to the left upper quadrant. The surgeon and the camera assistant stood on the patient's right side, and the first assistant stood on the left. The ports were introduced in a mirror image of the conventional setup. The SIT was confirmed using a telescope via an umbilical incision. A laparoscopic exploration of the CBD with a cholecystectomy was carried out successfully. The postoperative course was uneventful. This report shows that a CBD stone in a patient with SIT can be treated safely using laparoscopic surgery.

Laparoscopic surgery in situs inversus: a literature review and a report of laparoscopic sigmoidectomy for diverticulitis in situs inversus

BACKGROUND

Situs inversus (SI) is a rare autosomal recessive congenital defect in which the position of abdominal and/or thoracic organs is a "mirror image" of the normal one, in the sagittal plain. In 25% of these cases, SI is part of the Kartagener syndrome, together with bronchiectasis and chronic sinusitis.

METHODS

We present a case of a patient with Kartagener syndrome and complete SI that was laparoscopically operated on for diverticulitis. We also review the published English information available on this rare condition.

RESULTS

A review of the literature revealed another single case of laparoscopic sigmoidectomy and 27 cases of other laparoscopic interventions in the presence of SI. Those laparoscopic procedures included basic procedures such as explorations and cholecystectomies, as well as advanced procedures such as gastrectomy and gastric bypass.

CONCLUSION

The laparoscopic approach is feasible in cases of SI, although technically more complicated because of the different position of the organs and the different laparoscopic view of the anatomy.

Laparoscopic cholecystectomy in situs inversus totalis: is it safe?

A 46-year-old woman with known situs inversus totalis and recent mitral valve replacement presented with nausea and vomiting. Ultrasonography demonstrated a left-sided microlithiasic gall-bladder. Laparoscopic cholecystectomy was performed successfully. The postoperative recovery was uneventful. The literature on this subject is reviewed.

Feasibility of laparoscopic cholecystectomy in situs inversus

PURPOSE

To address the feasibility and safety of laparoscopic cholecystectomy in situs inversus and highlight the necessary modifications in the surgical technique.

PATIENTS AND METHODS

We present our experience in two patients with situs inversus and symptomatic gallstones who were treated successfully by laparoscopic cholecystectomy. The surgeon stood on the right side with the video monitor above the patient's left shoulder. Two 10-mm ports were placed in the epigastric and subumbilical positions. Two 5-mm ports were placed in the left mid-clavicular and left anterior axillary lines. The two procedures were carried out uneventfully after reorientation of the visual-motor skills of the surgeon and cameraman to the left upper quadrant. A summary of a further similar 13 cases so far treated in the English-language medical literature is also presented.

RESULTS

Skeletonizing the structures in Calot's triangle consumed extra time and was more difficult than in patients with a normally sited gallbladder. However, the hospital stay and postoperative complications were similar.

CONCLUSION

Laparoscopic cholecystectomy in situs inversus seems to be feasible and safe provided it is performed by an expert laparoscopic surgeon who takes time in clearly demonstrating the extrahepatic mirror image anatomy of the biliary tree with its right-to-left shift.

Laparoscopic cholecystectomy in a patient with situs inversus totalis

Situs inversus is a rare anomaly characterized by transposition of organs to the opposite side of the body. In this group of patients, cholelithiasis is observed with a frequency similar to the normal population. Herein, we report a patient with situs inversus totalis who underwent a successful laparoscopic cholecystectomy. Diagnostic pitfalls and technical details of the operation are discussed in the context of the available literature.

ERCP and laparoscopic cholecystectomy for cholangitis in a 66-year-old male with situs inversus

A case report of the successful management of a patient with situs inversus viscerum and symptomatic choledocholithiasis and cholangitis is presented. The preoperative evaluation of the choledochus via ERCP and successful common bile duct stone extraction enabled successful laparoscopic cholecystectomy. The anatomic challenge of situs inversus viscerum mandates the selective use of intraoperative cholangiography during and upon completion of the laparoscopic cholecystectomy.