Cholecystectomy in Situs Inversus Totalis

Abstract

Situs inversus totalis (SIT) involves a systemic reversal of visceral organs, complicating both clinical diagnosis and operative strategy. While laparoscopic cholecystectomy is the gold standard for cholelithiasis, its application is challenged by this rare anatomical anomaly. In cases of SIT with dextrocardia, atypical presentations and mirrored anatomy can obscure diagnosis and increase operative complexity. A 39-year-old man was diagnosed with dextrocardia via chest X-ray. Ultrasonography and computed tomography confirmed SIT, cholecystitis, and cholelithiasis. We attempted laparoscopic cholecystectomy using a modified technique involving left-handed maneuvers and adjusted port positions. However, due to dense adhesions between the gallbladder, omentum, and transverse colon, a Critical View of Safety (CVS) could not be achieved. The procedure was converted to an open cholecystectomy via a left subcostal incision. The operation went well, and our patient recovered satisfactorily.