A Case of Laparoscopic Cholecystectomy for Acute Cholecystitis in a Patient with Situs Inversus Totalis

Abstract

A 79-year-old man who had previously been diagnosed as having complete situs inversus totalis (SIT) visited our hospital with the chief complaints of fever and diarrhea. Physical examination revealed distention of the abdomen and signs of peritoneal irritation in the upper left abdomen. Blood biochemistry revealed an increased inflammatory response and elevated levels of hepatobiliary enzymes. CT showed a swollen gallbladder and thickening of the gallbladder wall. Imaging studies showed no anatomical abnormalities other than SIT. We diagnosed the patient as having acute cholecystitis and performed laparoscopic cholecystectomy. A camera port was inserted below the navel. With the head up and the patient rotated to his left, the port in the epigastrium and midway below the left costal arch served as the port for the operation, and the port outside the left costal arch served as the port for the assistant. Although the gallbladder showed fibrosis and hemorrhage due to inflammation, it could be safely removed. Intraoperative cholangiography confirmed the absence of any bile duct damage. The postoperative course was favorable, and the patient was discharged from the hospital on day 7 after the operation.