Laparoscopic cholecystectomy in situs viscerum inversus totalis

Gastric Cancer With Situs Inversus Totalis: A Case Report With More Than Five Years of Follow-Up

In Saudi Arabia, gastric cancer is a major health burden, ranking as the thirteenth most common cancer type. Situs inversus totalis (SIT), which is a very rare congenital anomaly, refers to a completely reversed location of the abdominal and thoracic organs (mirror image of the normal). Here, we present the first reported case of gastric cancer in an SIT patient in Saudi Arabia and the Gulf Cooperation Council (GCC) countries, and highlight the challenges faced by the surgical team in the removal of such cancer in this patient population.

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.

Laparoscopic duodenoduodenostomy in a newborn with situs inversus totalis

Situs viscerum inversus is a rare embryologic anomaly with a mirror-image transposition of the normal anatomy of organs. The coexistence with the duodenal atresia is extremely rare. This report describes a newborn with duodenal atresia and situs inversus totalis who was managed laparoscopically. According to our knowledge, this is the first report of this type of associated anomaly to be successfully managed by the laparoscopic approach.

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.