Laparoscopic cholecystectomy in patient with situs inversustotalis: Diagnostic and treatment pitfalls

Abstract

Roberto Marcellus de Barros Sena, Marcelo Barros Weiss, Ana Paula Teixeira de Abreu, Luisa Pires Costa, Rodrigo Pereira Peixoto, Camila Couto Gomes, Ana Paula Fernandes Braga, Felipe Couto Gomes, Carlos Augusto Gomes

Situs inversus totalis, a rare congenital recessive autosomal malformation described in humans by Fabricius, in 1600, is characterized by the viscera’s transposition. It presents the incidence of approximately one case to each 10.000-20.000 newborns. The main etiology is still unknown and when the abdominal and thoracic visceral commitment is associated, including dextrocardia, it is described as situs inversus totalis. We report the case of a female patient, 16-years-old, who came to the Digestive Surgical Department, in hospital Therezinha de Jesus, Juiz de Fora – MG – Brazil, complaining of pain in the left hypochondrium, associated to nauseas and vomiting. The patient mentioned that she had been suffering for 4 months and that the pain worsened in the previous 2 days. At the general clinical examination, she presented a cardiac focus ausculta in the right hemithorax, however, without abnormalities. The abdomen was flat, without surgical scars, ventral or inguinal hernias. There was hyperthermia, pain in the deep palpation on the left hypochondrium, associated guarding and rebound tenderness. The patient told that she had a previous diagnosis of situs inversus totalis. The aim of this case report is to describe a patient with cholecystitis associated with situs inversus totalis, who was previously aware of her congenital abnormality. Moreover, we review some aspects for the correct diagnosis, and propose recommendations for a safe laparoscopic cholecystectomy.