Ibrahim A Salama, MDpHD. Department of Hepatobiliary Surgery, National Liver Institute, Menoufia University
INTRODUCTION: Situs inversus totalis is a rare anomaly characterized by transposition of organs to the opposite site of the body. Combined Laparoscopic Splenectomy and cholecystectomy in those patients is technically more demanding and needs reorientation of visual-motor skills.
PRESENTATION OF CASE: Herein, we report a 16 year old girl presented with yellowish discoloration and left hypochondrium and epigastric pain diagnosed as Hereditary Spherocytosis (HS). The patient had not been diagnosed as situs inversus totalis before. The patient exhibit a left sided “Murphy’s sign” and spleen palpable in right hypochondruim. Diagnosis of situs inversus totalis was confirmed with Ultrasound, Computerized Tomography (CT) and Magnetic Resonant Image (MRI) with enlarged right sided spleen and presence of multiplegall bladder stones with no intra or extrabiliary duct dilatation. The patient underwent combined laparoscopic Splenectomy and cholecystectomy as treatment of Hereditary Spherocytosis (HS).
DISCUSSION: Feasibility and technical difficulty in diagnosis and treatment of such case pose challenge problem due to the contra lateral disposition of the viscera. Difficulty is the laparoscopic technique encountered in skelatonizing the structures in Calot’s triangle, which consume extra time than normally located gall bladder with right sided standing surgeon and the position changed to left sided standing surgeon during splenectomy. In review up to date medical literature this is the first case reported worldwide. .
CONCLUSION: Provided that the technique is performed by an experienced surgical team, concomitant laparoscopic splenectomy and cholecystectomy in situs inversus totalis is a safe and feasible procedure and may be considered for coexisting spleen and gallbladder disease as in Hereditary Spherocytosis (HS) as changes in anatomical disposition of organ not only influence the localization of symptoms and signs arising from a diseased organ but also imposes special demands on the diagnosis and surgical skills of the surgeon.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86432
Program Number: P711
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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