Intraoperative Diagnosis of Situs Inversus Totalis in Laparoscopic Cholecystectomy: Taking Into Consideration Patient-Centered Care in a Limited-Resource Case

TL;DR

This paper discusses the intraoperative diagnosis and management of a rare condition during a routine surgical procedure, emphasizing the importance of adaptability and accurate diagnosis for patient safety.

Contribution

The paper highlights the challenges and considerations in performing laparoscopic cholecystectomy in a patient with situs inversus totalis.

Findings

Situs inversus was confirmed intraoperatively during a scheduled laparoscopic cholecystectomy.

Trocar placement was adjusted to the left side to accommodate the mirrored anatomy.

Accurate preoperative diagnosis is essential for safe surgical planning in such cases.

Abstract

Situs inversus (SI) is a rare congenital disorder in which the abdominal and thoracic organs create a mirror image orientation of their typical anatomical positions. In this article, we present the case of a 49-year-old female individual who underwent a scheduled laparoscopic cholecystectomy (LC) due to postprandial colic pain in the epigastrium. A prior ultrasound examination, conducted a year earlier, revealed the presence of small gallstones within the gallbladder, and a follow-up preoperative ultrasound suggested the possibility of SI, though the diagnosis was ruled out by a third ultrasound. Standard LC was commenced with umbilical trocar placement; however, SI was confirmed, and trocar placement was mirrored to the left side. Accurate preoperative diagnosis is crucial for surgical planning and to ensure patient safety. Performing an LC on a patient with SI poses unique challenges and requires heightened surgical skills and adaptability by the operating surgeon with extensive anatomical knowledge to mitigate risks and optimize patient outcomes.

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