title: Laparoscopic cholecystectomy in two patients with symptomatic cholelithiasis and situs inversus totalis.
abstract: BACKGROUND
  Situs inversus viscerum is a rare condition with a genetic predisposition. We report 2 patients with situs inversus totalis and symptomatic cholelithiasis successfully treated via laparoscopic cholecystectomy.
  
  
  METHODS
  The first patient was a 61-year-old female presenting with pain in the left upper quadrant associated with fever, chills, nausea and vomiting. The abdomen was tender with guarding and rebounding pain in the same region. Abdominal ultrasound and CT scan confirmed the diagnosis of gallstones as well as situs inversus with the liver and gallbladder on the left side and the spleen on the right. The second patient was a 37-year-old male with known situs inversus who presented with biliary colic due to cholelithiasis. In both patients cholecystectomy was performed laparoscopically in a reverse fashion.
  
  
  RESULTS
  Laparoscopic cholecystectomy was carried out successfully despite the reversed anatomic relationships and both patients made a smooth recovery.
  
  
  CONCLUSIONS
  Cholelithiasis occurring with situs inversus totalis is rare and may present a diagnostic problem. Laparoscopic cholecystectomy can be safely and effectively applied in the setting of situs inversus, although attention must be paid to the details of left-right reversal.
authors.affiliation: 4th Surgical Department, Aristotle University of Thessaloniki, G Papanikolaou General Hospital, Greece.
authors.forename: H
authors.initials: H
authors.lastname: Demetriades
authors.forename: D
authors.initials: D
authors.lastname: Botsios
authors.forename: C
authors.initials: C
authors.lastname: Dervenis
authors.forename: J
authors.initials: J
authors.lastname: Evagelou
authors.forename: S
authors.initials: S
authors.lastname: Agelopoulos
authors.forename: J
authors.initials: J
authors.lastname: Dadoukis
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000000981:diagnostic imaging / Q000601:surgery; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012857:Situs Inversus / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed