Laparoscopic Cholecystectomy in a 39-Year-Old Female with Situs Inversus

Abstract

Kartagener syndrome consists of situs inversus, chronic sinusitis, and bronchiectasis. A 39-year-old woman known to have Kartagener syndrome presented with complaints of left upper abdominal quadrant pain. Suspicion of cholelithiasis was confirmed with ultrasound and oral cholecystogram. The patient underwent a laparoscopic cholecystectomy. Standard techniques were modified in mirror image fashion to provide access to the left upper quadrant. This unusual presentation of chronic calculus cholecystitis in a patient with Kartagener syndrome demonstrates the adaptability of laparoscopic cholecystectomy technique.

Situs Inversus: Open Cholecystectomy and Appendectomy: A literature Review

“…The diagnosis of gallstone disease is difficult because of left sided pain although a few of patients develop epigastric pain [9,10]. Though situs invertus is associated with multiple congenital anomalies but it does not make patient prone to gall stones [5]. The incidence of cholelithiasis is same in situs inversus as in the general population.…”

“…Laparoscopic cholecystectomy is the gold standard treatment for symptomatic gall stone disease in normal population. The first known report on laparoscopic cholecystectomy in a patient with situs inversus was by Campos and Sipes in 1991 [5]. According to search 37 cases of gall bladder pathology were managed through laparoscopic cholecystectomy without complications [11,12].…”

“…In association with dextrocardia it is called situs invertus totalis and exhibit complex features and difficulties to diagnose because of altered position of vessels and organs [3,4]. Approximately 20-25% of those diagnosed with situs inversus have associated congenital anomalies, such as renal dysplasia, biliary atresia, congenital heart disease, bronchiectasis, infertility and ciliary dyskinesia [5,6].…”

Laparoscopic Cholecystectomy in Kartagener Syndrome

“…3 Only two cases of such patients requiring cholecystectomy for gallstone disease have been reported in English literature. 3,4 In one patient, laparoscopic cholecystectomy was carried out, 3 while in another case, open cholecystectomy was done under regional anesthesia due to cardiorespiratory disorders.…”

“…2 There are very few reports of laparoscopic surgery in Kartagener syndrome because of associated respiratory disorders. 3,4 Anatomy of the abdominal organs in such a patient is distorted, making laparoscopic surgery difficult. We report a rare case of Kartagener syndrome with gallstone disease managed successfully by laparoscopic cholecystectomy.…”