title: Management of a patient with situs inversus totalis with acute cholecystitis and common bile duct stones: A case report.
abstract: BACKGROUND
  The incidence of situs inversus thought to be in the range of 1:10,000-1:20,000 according to Mayo et al.
  
  
  METHODS
  A forty-five year-old lady presented with pain in the left hypochondrium and was diagnosed to have acute cholecystitis with choledocholithiasis in situs inversus totalis. Patient underwent endoscopic sphincterotomy and common bile duct stone extraction in view of choledocholithiasis and after common bile duct cannulation patient taken up for elective laparoscopic cholecystectomy (LC) within 24h.
  
  
  CONCLUSIONS
  The most challenging factor for performing surgery in a patient with situs inversus is dealing with the mirror image anatomy. The first laparoscopic cholecystectomy in situs inversus was reported by Campos et al. in 1991. Since then, 50 other cases have been reported in literature making a point that laparoscopic procedure is not contraindicated.
  
  
  CONCLUSIONS
  Acute cholecystitis with choledocholithiasis is extremely rare and requires expert intervention from both the endoscopist and the laparoscopic surgeons because of the reverse anatomy and the fact that both are attuned to the constant practice of the procedures in normal anatomy.
authors.affiliation: Department of General Surgery, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India. Electronic address: ashwanth1111@gmail.com.
authors.forename: Ashwanth
authors.initials: A
authors.lastname: Reddy
authors.affiliation: Department of General Surgery, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India.
authors.forename: Surendran
authors.initials: S
authors.lastname: Paramasivam
authors.affiliation: Department of General Surgery, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India.
authors.forename: Naveen
authors.initials: N
authors.lastname: Alexander
authors.affiliation: Department of General Surgery, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India.
authors.lastname: Abhilash
authors.affiliation: Department of General Surgery, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India.
authors.forename: Vigneshwar
authors.initials: V
authors.lastname: Ravisankar
authors.affiliation: Department of General Surgery, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India.
authors.forename: Manoj
authors.initials: M
authors.lastname: Thillai
keywords: Laparoscopic Cholecystectomy in Situs inversus totalis