Laparoscopic Cholecystectomy in a Patient with Situs Inversus Totalis and a Double Superior Vena Cava

Abstract

Rare coexistence of disease or pathology Background:Situs inversus totalis (SIT) is an uncommon condition characterized as a congenital disorder in which the visceral organs are inverted relative to their typical anatomical position. SIT with double superior vena cava (SVC) is an even rarer presentation. Due to the underlying anatomical difference, the diagnosis and treatment of gallbladder stones in patients with SIT are challenging. Case Report:We report the case of a 24-year-old male patient who presented with an intermittent history of epigastric pain for 2 weeks. Clinical assessment and radiological investigations confirmed gall bladder stones with evidence of SIT and double superior vena cava (SVC). The patient underwent elective laparoscopic cholecystectomy (LC) with an inverted laparoscopic approach. The recovery from the operation went smoothly, the patient was discharged from the hospital the following day, and the drain was removed on the third postoperative day. Conclusions:Because anatomical variations in the SIT can affect localization of symptoms in patients with complicated gallbladder stones, the diagnosis of patients who have abdominal pain and SIT necessitates both a high index of suspicion and a thorough assessment. Although LC is considered to be a technically challenging surgery and calls for modification of the standard protocol, it is nevertheless feasible to perform the procedure effectively.To the best of our knowledge, this is the first time that LC has been documented in a patient who has SIT and double SVC.

Colecistectomía con exploración de vías biliares laparoscópica en paciente con situs inversus totalis

“…Los cirujanos y gastroenterólogos rara vez ven pacientes con SI debido a su rareza; esta anomalía podría presentarse incluso al cirujano más experimentado en 1 o 2 veces en toda su carrera (11) . La presencia de SIT no contraindica la realización de la CL, aunque es dificultosa, esta se considera el tratamiento de primera elección en colelitiasis, siendo un método seguro, pero que demanda una reorientación de la habilidad motora y visual (1,3) , esto debido a los problemas asociados al SIT como la imagen "en espejo", las variaciones anatómicas, el posicionamiento de los puertos, y la dominancia de la mano del cirujano (1) .…”