Left-Sided Abdominal Pain Revealing Acute Cholecystitis in Situs Inversus Totalis: Diagnostic Pitfalls and Surgical Considerations

TL;DR

A rare case of situs inversus totalis with acute cholecystitis presented with left-sided pain, highlighting diagnostic and surgical challenges.

Contribution

This case report emphasizes the need to consider anatomical variants in atypical abdominal presentations.

Findings

Acute cholecystitis in situs inversus totalis can present with left-sided pain, risking misdiagnosis.

Laparoscopic cholecystectomy using mirrored port placement was successfully performed in this case.

Early imaging and surgical adaptation are crucial for safe management in such patients.

Abstract

Situs inversus totalis is a rare congenital condition that can complicate the diagnosis and management of acute abdominal pathology due to atypical symptom localization. Acute cholecystitis in this setting may present with left-sided abdominal pain, increasing the risk of misdiagnosis and delayed treatment. The scientific rationale for this case report is to emphasize the importance of recognizing anatomical variants when evaluating atypical abdominal presentations. We report the case of a 65-year-old woman who presented with left upper quadrant pain, nausea, and vomiting. Imaging studies demonstrated dextrocardia and complete mirror-image transposition of the thoracic and abdominal organs, consistent with situs inversus totalis, along with findings of acute calculous cholecystitis. The patient underwent laparoscopic cholecystectomy using a mirrored port placement technique without complications and had an uneventful recovery. This case highlights that early use of imaging and appropriate surgical adaptation enable safe laparoscopic management. Future research should focus on multicenter data to better characterize diagnostic delays and refine surgical strategies in patients with situs inversus totalis.

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