A Case of Situs Inversus Totalis with Gallbladder Stones Treated by Laparoscopic Surgery

Summary

We present a protocol for three-port laparoscopic cholecystectomy in patients with situs inversus totalis and gallbladder stones, detailing preoperative imaging optimization, mirrored anatomy adaptations, and intraoperative safety strategies to achieve successful minimally invasive treatment.

Abstract

Situs inversus totalis, also known as mirror man, is an extremely rare anatomical variant in which the positions of the thoracic and abdominal organs are reversed. This case is novel due to the combination of situs inversus totalis and gallbladder stones, presenting unique surgical challenges. Reporting this case underscores the importance of preoperative imaging and surgical technique adjustments for achieving a successful laparoscopic cholecystectomy in such rare anatomical variants. A 58-year-old female patient presented with recurrent left-sided low back pain for over 2 months, exacerbated in the previous 2 days. She had no major medical history. Imaging revealed gallbladder stones with situs inversus totalis. Preoperative evaluation included comprehensive imaging to assess biliary tract variations. Laparoscopic cholecystectomy was performed using a three-port approach, with careful adjustments for the mirrored anatomy. The operation was successful, with minimal intraoperative bleeding (20 mL) and no complications. The patient recovered well, started eating and mobilising on the first postoperative day and was discharged on the third day. Follow-up at 3 months showed no considerable discomfort, and a 1-year telephone follow-up confirmed sustained recovery. This case highlights the importance of thorough preoperative imaging and surgical planning in managing patients with situs inversus totalis. The successful laparoscopic cholecystectomy demonstrates that, with careful preparation and technique adjustments, minimally invasive surgery can be safely performed even in rare anatomical variants. This experience provides valuable insights for surgical teams encountering similar cases, emphasising the need for meticulous preoperative assessment and intraoperative adaptability.

Introduction

Situs inversus totalis, known as mirror man, is an extremely rare anatomical variant of human viscera, referring to complete thoracic and abdominal visceral inversion, in which the anatomical parts are opposite to those of normal humans^1,2. There are two main views on the mechanism of its occurrence: visceral rotation disorders during embryonic development³ and abnormal genes carried on the chromosomes of both parents⁴. When combined with other conditions, such as gallbladder stones, surgical interventions become considerably more challenging

Protocol

The procedure was approved and conducted as per the ethical guidelines of the First Affiliated Hospital of Baotou Medical College. The patient provided written informed consent for publication of this case report, including all details and images. The consent form was explained to the patient to ensure understanding of the purpose of publication and the information to be shared. All personal identifying information was anonymized in accordance with ethical guidelines and hospital policies to protect patient privacy.

1. Patient positioning and anesthesia

1. The patient was placed under general anesthesia and positioned in the revers....

Results

The procedure lasted 75 min, with an estimated blood loss of 20 mL. No intraoperative complications occurred. Preoperative and postoperative clinical data were systematically collected to validate the protocol, including key indicators such as abdominal tenderness, laboratory test results, functional recovery status, and pain scores (Table 1).

The patient resumed oral intake and ambulation on postoperative day 1 and experienced mild abdominal pain (numeric rating scale score o.......

Discussion

The success of laparoscopic cholecystectomy in situs inversus totalis relies on three critical protocolised steps. First, optimization of preoperative imaging with MRCP is essential to map mirrored anatomy and rule out biliary tract variants, as anatomical ambiguity increases the risk of injury⁸. Magnetic resonance cholangiopancreatography provides detailed visualisation of the left-sided gallbladder, cystic duct and common bile duct, which guided port placement and dissection strategy in this cas.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Anesthesia machine	Datex-Ohmeda	Aisys CS2 (https://www.gehealthcare.com)	General anesthesia system
Energy device	Ethicon	GEN11 (https://www.ethicon.com)	Ultrasonic dissecting device
Hem-o-lok clips	Teleflex	HCL-35 (https://www.teleflex.com)	Medium vascular clips
Laparoscope	Karl Storz	301230 (https://www.karlstorz.com)	10 mm 30° rigid laparoscope
Laparoscopic dissector	Karl Storz	341610 (https://www.karlstorz.com)	Curved dissecting forceps
Pneumoperitoneum insufflator	Karl Storz	264300 (https://www.karlstorz.com)	CO? insufflator with pressure monitoring
Trocar	Ethicon	4205210 (https://www.ethicon.com)	10 mm supraumbilical trocar
Trocar	Ethicon	4205210 (https://www.ethicon.com)	10 mm subxiphoid trocar
Trocar	Ethicon	4205150 (https://www.ethicon.com)	5 mm left midclavicular line trocar