Acute Cholecystitis in Two Patients Carrying a Situs Inversus: A Diagnostic and Therapeutic Challenge

Anis Haddad,Amine Sebai,Souhaib Atri,Amine Daghfous,Zoubeir Ben Safta

doi:10.4172/2165-7920.10001000

Abstract

The situs inversus is a rare anatomical condition which is characterized by the transposition of organs towards the opposite side. The left position of the gall-bladder makes the diagnosis of acute cholecystitis difficult because of an unusual symptomatology. It is also associated with a difficulty of laparoscopic dissection of the stone-block triangle especially for the right-handed surgeons. We report the cases of 2 patients whose different explorations confirmed the diagnosis of acute cholecystitis and total situs inversus and benefited from a laparoscopic cholecystectomy. Laparoscopic cholecystectomy, in these two cases, is an original intervention because of the mirrored vision of the intraperitoneal organs and can even be difficult leading to iatrogenic complications. However, the laparoscopic approach remains the gold standard even in the presence of this mirrored anatomy.

Highlights

The situs inversus is a rare anatomical condition which is characterized by the transposition of organs towards the opposite side
We report the cases of 2 patients carrying a totalsitus inversus who benefited from a laparoscopic cholecystectomy for acute cholecystitis
Abdominal ultrasound confirmed the diagnosis of acute cholecystitis and total situs inversus

Summary

Introduction

The situs inversus is a rare anatomical condition which is characterized by the transposition of organs towards the opposite side. The left position of the gall-bladder makes the diagnosis of acute cholecystitis difficult because of an unusual symptomatology. It is associated with a difficulty of laparoscopic dissection of the stone-block triangle especially for the right-handed surgeons. The chest X-ray of the thorax (Figure 1) showed a dextrocardia suggesting the diagnosis of situs inversus. Abdominal ultrasound confirmed the diagnosis of acute cholecystitis and total situs inversus. The exploration intraoperative confirmed the diagnosis of acute cholecystitis and the situs inversus (Figure 4). Mr SN, 54-year-old, male was hospitalized for fever and pain of the left hypochondrium This patient was known carrier of a situs inversus complete. The radiological and biological explorations confirmed the diagnosis of acute cholecystitis on total situs inversus.

Discussion

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Conclusion