The Management and Challenges of Laparoscopic Cholecystectomy in Situs Inversus Abdominalis.

ABSTRACT

Left-sided gallbladders are rare anatomical variations and a result of an abnormal embryological process. The most frequent cause for a sinistroposition gallbladder is the presence of situs inversus. We present a case of a 51-year-old male referred to the General Surgery consult due to cholelithiasis with a history of occasional post-prandial abdominal pain in the left hypochondrium and nausea associated with the ingestion of lipid-rich meals. The ultrasound revealed a gallbladder filled with calculous but without inflammatory signs or bile duct dilation, in the sinistroposition. Magnetic resonance imaging (MRI) confirmed and excluded further anatomic variations. The patient underwent a laparoscopic cholecystectomy due to symptomatic cholelithiasis without any complications and was discharged the following day. When faced with a patient with gallbladder/biliary duct disorders associated with situs inversus, one must have a high clinical index of suspicion to properly diagnose and the mental agility to adapt and further operate in a mirrored-positioned abdomen. In these situations the patient should always undergo a prior MRI to determine the correct anatomy of the biliary system and the surgeon should perform an intraoperative cholangiography if any other variations are suspected. The presence of situs inversus thus imposes a surgical and diagnostic challenge. Although rare the surgeon must be aware of this possibility.