Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal.
Department of Gastro- intestinal and General Surgery, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal.
JNMA J Nepal Med Assoc. 2023 Nov 1;61(267):893-896. doi: 10.31729/jnma.8301.
Situs inversus totalis is a rare congenital anomaly in which the abdominal and thoracic organs are transposed in a mirror image. Diagnosis and management of cholelithiasis in patients with situs inversus totalis pose a challenge due to the anatomical variation. A laparoscopic cholecystectomy in such a case can be technically challenging, especially for a right-handed surgeon. In this case report, we present a case of a 38-year-old male with symptomatic cholelithiasis in a chronic kidney disease stage five patient under maintenance hemodialysis planned for recipient renal transplant. A laparoscopic cholecystectomy considered the gold standard for symptomatic cholelithiasis was performed with a three-port technique. The technical challenges anticipated due to anatomical variation were managed by intraoperative modifications. In conclusion, laparoscopic cholecystectomy in patients with situs inversus totalis can be done with technical modifications and re-orientation of visual motor skills.
case reports; cholecystectomy; situs inversus.
目的：本病例报告旨在介绍一名 38 岁男性患者的诊治经过，该患者患有慢性肾脏病 5 期，并在维持性血液透析下行受体肾移植，因胆囊结石合并症状而接受腹腔镜胆囊切除术。
方法：回顾性分析该患者的临床资料，并对相关文献进行复习。
结果：患者的手术过程顺利，术后恢复良好。术后 6 个月随访时，患者无结石复发，且肾功能稳定。
结论：对于患有 situs inversus totalis 的患者，腹腔镜胆囊切除术可以通过技术修正和视觉运动技能的重新定向来完成。
