Laparosc Endosc Surg Sci . 2017; 24(4): 133-135 | DOI: 10.14744/less.2018.60490

Laparoscopic cholecystectomy and intraoperative cholangiography in a patient with situs inversus totalis

Mehmet Gökçeimam, Burak Güney, Emin Köse, Deniz Tazeoðlu, Mehmet Can Aydýn, Kadir Meke, Servet Rüþtü Karahan
Department of General Surgery, Health Sciences University Okmeydaný Training and Resarch Hospital, Ýstanbul, Turkey

Situs inversus totalis (SIT) is a congenital autosomal recessive abnormality in which the visceral organs are transposed in a mirror-image position from the normal location. Laparoscopic surgery must be performed with different patient positioning and trocar placement. Presently described is the approach used on a patient with this rare condition. A 39-year-old female with no other known disease but SIT was referred to the emergency department with symptoms of biliary colic. Cholestatic and liver enzymes were elevated, but the white blood cell count was normal. Magnetic resonance cholangiopancreatography was performed but yielded no additional finding. A month later, a laparoscopic cholecystectomy was performed. The patient was placed in the supine position. The operating room layout, trocar placement, and patient positioning were adapted for the circumstances, and small modifications were made to the surgery technique. With these adjustments, a cholecystectomy can be performed as safely in a patient with SIT as in those with normal anatomy. Intraoperative cholangiography was also performed. Cholecystectomy was completed without complication. Although SIT is rare, it should be considered attentivelty. The surgeon must work outside the normal routine since the anatomy must be considered differently. As seen in this case report, surgery can be completed without any problem with the proper approach and planning.

Keywords: Cholelithiasis, gallstones; laparoscopy; situs inversus totalis.

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Situs Ýnversus Totalisli hastada Kolanjiyografi eþliðinde Laparoskopik Kolesistektomi

Mehmet Gökçeimam, Burak Güney, Emin Köse, Deniz Tazeoðlu, Mehmet Can Aydýn, Kadir Meke, Servet Rüþtü Karahan
T.C. Saðlýk Bilimleri Üniversitesi Okmeydaný Eðitim Araþtýrma Hastanesi

GÝRÝÞ:
Situs Ýnversus Totalis(SÝT), otozomol resesif kalýtýlan, vücudun organ sistemlerinin normal lokalizasyonlarýnýn yerine simetrik olarak karþý tarafta yer almasý olarak tanýmlanan bir anormal durumdur. Bu hastalarda özellikle laparoskopik cerrahi normalden farklý hasta pozisyonlandýrmasý, trokar giriþleri gibi sebeplerden ötürü özellik arz etmektedir.
OLGU:
SÝT durumu bilinen, özgeçmiþinde ek hastalýðý olmayan 39 yaþýnda bayan hasta, acile baþvurdu. Karaciðer ve kolestaz enzimlerinde ve bilirubin deðerlerinde minimal artýþ görülen hastada lökositoz yoktu. MRCP deðerlendirmesinde ek özellik görülmeyen hastada medikal tedaviden bir ay kadar sonra elektif laparoskopik kolesistektomi uygulandý.
Hasta ameliyat masasýna prone pozisyonda yerleþtirildi. Ameliyathane düzeni ve trokar yerleri farklý þekilde tasarlandý. Ek düzenlemelerle de kolesistektomi normal anatomiye sahip olanlardaki kadar güvenli yapýlabilmektedir. Ýntraoperatif kolanjiografi çekilen hastada cerrahi komplikasyonsuz tamamlandý.
SONUÇ:
SÝT az görülmekle beraber, cerrahýn normal rutin yaklaþýmýnýn dýþýna çýkmasý gerekliliði nedeniyle önem arz etmektedir. Olgu sunumumuzda görüldüðü üzere doðru yaklaþým ve planlamayla problemsiz bir þekilde cerrahi tamamlanabilmektedir.

Anahtar Kelimeler: kolelityazis, laparoskopi, safra taþý, situs inversus totalis

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