Laparoscopic cholecystectomy with choledochoduodenostomy in a patient with situs inversus totalis

Abstract

A 50-year-old female presented to us with features of obstructive jaundice. Investigations revealed cholelithiasis with single large impacted calculus in the common bile duct (CBD) and significant dilatation of extrahepatic biliary tree. Incidentally, the patient was also detected to have situs inversus totalis (SIT). Attempt at extraction of the calculus in the CBD by endoscopic retrograde cholangiography failed, and a 7F stent was placed. The patient was subjected to laparoscopic cholecystectomy, CBD exploration with the extraction of the offending calculus and laparoscopic choledochoduodenostomy (LCDD). The patient had an uneventful recovery and is since discharged. PubMed search did not reveal LCDD in SIT as a procedure reported in literature to the best of our knowledge.

Minimally Invasive Versus Open Treatment for Benign Sporadic Insulinoma Comparison of Short‐Term and Long‐Term Outcomes

“…To overcome this problem, intraoperative ultrasonography is a reliable tool [15, 20]; however, the use of other aids such as laparoscopic palpation, frozen sections and intraoperative blood sugar monitoring has been proposed as help, but their use is still debated [16]. Once the location has been defined, the feasibility should be evaluated, taking account of the distance from the pancreatic duct (more than 3 mm) or portal vein (in lesions of pancreatic head) and excluding the possibility of malignancy [20].…”

“…This fact is caused by the difficulty to identify the lesion intraoperatively without the possibility of bidigital palpation. Intraoperative ultrasonography [15] such as other aids [16] could help to overcome this limitation during the minimally invasive approach [15]. The aim of the present retrospective study was to perform a comparison of minimally invasive enucleation compared to the open approach.…”

Laparoscopic common bile duct exploration to treat choledocholithiasis in situs inversus patients: A technical review

“…Also, one patient had undergone LC before, but residual gallbladder and CBD stones were found six months later[ 17 ]. The presentation in four of these patients was jaundice[ 15 , 19 , 21 ], while four patients developed cholecystitis[ 8 , 15 , 19 ]. Additional high-resolution imaging was used to assess the abdominal anatomy in six patients: Two patients underwent abdominal CT only[ 16 ], magnetic resonance cholangiopancreatography (MRCP) was used in two cases[ 18 , 19 ], and two patients underwent both CT and MRCP[ 8 , 21 ].…”

“…In our literature review of LCBDE in SI patients (Table 2 ), although some of the patients ambiguously described their operative technique as "conventional"[ 8 , 15 , 20 ], most of them reported a four-port technique with the American mirror style[ 18 , 19 , 21 ]. Our patient is the only case treated by SILCBDE.…”

“…In our literature review, choledochoscopy was used in three patients to conduct bile duct exploration[ 16 , 18 , 21 ]. Five patients underwent choledochotomy that closed by one T-tube drainage[ 21 ], one patient had primary closure[ 18 ], two patients had choledochoduodenostomies[ 17 , 19 ], and the remaining one patient had an unmentioned repair[ 16 ]. The only transcystic approach was applied in our case.…”