title: Cholecystectomy in situs viscerum inversus totalis. Does laparoscopy increase the pitalls?
abstract: Situs viscerum inversus is a rare condition in which the organs are transposed, totally or partially, to the opposite side of the body. Normally, there are no organ dysfunctions. Clinically, symptoms of cholelithiasis may be clear but confused by the location of the gallbladder on the opposite side. We report the case of a 43-year-old female with occasional colic pain in the epigastrium radiating to the right side and subscapular region, particularly after lunch. The laboratory findings showed normal values and, at physical examination, deep palpation of the abdomen in the epigastric region provoked pain. X-rays, ultrasonography, and CT scan showed the presence of multiple gallstones and the situs viscerum inversus of the abdominal organs. The only pathological finding was cholecystolithiasis. Laparoscopic cholecystectomy was judged advisable. Situs viscerum inversus is not a contraindication for laparoscopic cholecystectomy. This abnormal anatomical condition may create some initial difficulty for the surgeons, because of the inverted position of the organs. The peculiarity of our case is the unlikely site of the abdominal pain, located in the epigastrium and on the right side although the patient had situs viscerum inversus. Laparoscopic cholecystectomy can be performed on the left-sided gallbladder proceeding with the "american technique". In difficult cases, open cholecystectomy can be unavoidable.
authors.affiliation: General Surgery and Liver transplantation Unit, Department of Emergency and Organ Transplantation, University Medical School of Bari, Italia.
authors.forename: Francesco
authors.initials: F
authors.lastname: Puglisi
authors.forename: Vito Leopoldo
authors.initials: VL
authors.lastname: Troilo
authors.forename: Michele
authors.initials: M
authors.lastname: De Fazio
authors.forename: Palma
authors.initials: P
authors.lastname: Capuano
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lograno
authors.forename: Giorgio
authors.initials: G
authors.lastname: Catalano
authors.forename: Gennaro
authors.initials: G
authors.lastname: Martines
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Memeo
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D006801:Humans; D012857:Situs Inversus / Q000601:surgery*