Situs Inversus Totalis: Operating on the Mirror Image
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Hellenic Journal of Surgery (2020) 92:3-4, 150-152
Situs Inversus Totalis: Operating on the Mirror Image Avijit Roy1, Madhumita Mukhopadhyay2
Abstract Introduction: Situs inversus totalis is a rare congenital anomaly where the internal organs are located in the reverse
position, thus forming a mirror image of the normal distribution of organs in our body, i.e. situs solitus. Laparoscopic cholecystectomy in patients with situs inversus poses a challenge for the surgeon for its anatomical variation and reverse ergonomics. Presentation of the Case: Herein we report the case of a 27-year old lady who presented with pain over the left
hypochondrium often radiating to left scapular region associated with flatulence and dyspepsia. Ultrasonography revealed gall stone disease with situs inversus totalis, which was subsequently confirmed with CT scan of abdomen and echocardiography. Laparoscopic cholecystectomy was performed safely with the ports placed on the left side. Discussion: Patients with situs inversus may harbour other serious cardiorespiratory or intra-abdominal anomalies including anomalies of the extra-hepatic biliary tree. Performing laparoscopic cholecystectomy in them is difficult because of anatomical mirror imaging and ergonomical challenges. Prior diagnosis of the condition, proper workup and meticulous dissection at the Calot’s tringle by an experienced laparoscopic surgeon can end up with a safe surgical outcome. Conclusion: Safe laparoscopic cholecystectomy is feasible in patients with situs inversus provided the condition is diagnosed including the anatomical variations prior hand and the surgery is performed by an experienced laparoscopic surgeon. Moreover, every laparoscopic surgeon must be well conversant with the use of his/her left hand as well. Nowadays, robotic minimal access surgery can be a better solution to this problem. Key words: Situs inversus totalis; symptomatic gall stone disease; laparoscopic cholecystectomy
Introduction Situs inversus totalis is a congenital condition where there is transposition of the internal organs from their anatomically normal positions (situs solitus) to the opposite side of the body. Matthew Baillie, a British physician and pathologist, first described situs inversus totalis in 1743. It has a global prevalence of 1 in 10,000 to 1 in 35,000. The first case report of laparoscopic cholecystectomy of total situs inversus was published in 1991 by Campos and Sipes, who performed a mirror-image setup for the patient in supine position [1]. Since then, over 80 other reports have been published discussing the safety of laparoscopic cholecystectomy in patients with situs inversus totalis. A number of 1
Assistant Professor, Department of Surgery, Murshidabad Medical College and Hospital, West Bengal 2 Professor, Department of Surgery, Diamond Harbour Government Medical College and Hospital, West Bengal Corresponding author: DR Madhumita Mukhopadhyay Block 2, Flat No. 7A, Ekta Heights, 56, Raja S C Mullick Road, Kolkata 700032 Tel.: 9831397865, e-mail: drmmukherjee
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