Situs inversus totalis is a rare congenital condition present in approximately 0.01% of the population in which the major visceral organs are reversed from their normal position and can pose difficulties in the diagnosis and management of acute abdominal pathology. Symptomatic cholelithiasis is very common in India and laparoscopic cholecystectomy is the gold standard treatment at present. Laparoscopic surgery in a situation of situs inversus is challenging due to the mirror-image anatomy. Diagnostic pitfalls and technical details of the laparoscopic cholecystectomy are discussed.

Jejunal diverticula are uncommon, acquired lesions which are usually asymptomatic. When symptomatic they present with chronic non-specific symptoms like pain, nausea, malnutrition and sometimes with acute presentation like gastrointestinal hemorrhage, peritonitis and obstruction. While chronic pain and malabsorption occurs in 40% of cases, perforation occurs only in 2.3-6.4% of all diverticula bearing patients.

Superior mesenteric artery (SMA) syndrome is an uncommon cause of gastrointestinal tract obstruction which is accompanied with epigastric pain and vomiting. Normally, the angle created by the aorta and the SMA is between 45 -60 degrees. Any factor that narrows this aorto-mesenteric angle to less than 25 degrees can result in entrapment and compression of the third part of the duodenum and leading to the SMA syndrome. This paper describes our experience in the diagnosis and management of 5 cases of this rare entity in our tertiary care hospital.