Anesthetic management of a patient with situs inversus posted for laparoscopic cholecystectomy
Keywords:Cholecystectomy, General anesthesia, Laparoscopy, Situs inversus totalis
Situs inversus totalis is a rare congenital visceral malrotation anomaly that results from disturbances in establishment of left-right asymmetry. It is an autosomal recessive condition, in which organs are transposed from their normal location to the opposite side of the body and the predicted incidence is one in 10, 000 among the general population. In a patient with situs inversus totalis, not just the diagnosis of any acute abdomen pathology is difficult but equally challenging is the anesthetic management during the respective surgical procedure. We are reporting a patient who had situs inversus totalis and was operated for laparoscopic cholecystectomy under general anesthesia, and endotracheal tube as an airway conduit. Though the problems related to such patients are mainly of surgical feasibility, an anesthesiologist must be aware of the associated problems of both, situs inversus and the surgical procedures. The present case report lays an emphasis on the potential difficulties during anesthetic management and its various implications in a remote area in North East India with resource limitations. To the best of our knowledge, we report the first case from a remote are in North East India of a successful laparoscopic cholecystectomy in a patient with situs inversus totalis under general anesthesia which was uneventful.
McKay D, Blake G. Laparoscopic cholecystectomy in situs inversus totalis: a case report. BMC Surg. 2005;5:5.
Kumar S, Fusai G. Laparoscopic cholecystectomy in situs inversus totalis with left-sided gall bladder. Ann R CollSurg Engl. 2007;89:W16-8.
Aydin U, Unalp O, Yazici P, Gurcu B, Sozbilen M, Coker A. Laparoscopic cholecystectomy in a patient with situs inversus totalis. World J Gastroenterol. 2006;12:7717-9.
Patle NM, Tantia O, Sasmal PK, Khanna S, Sen B. Laparoscopic cholecystectomy in situs inversus-our experience of 6 cases. Indian J Surg. 2010;72:391-4.
Mathew PJ, Sadera GS, Sharafuddin S, Pandit B. Anaesthetic considerations in Kartagener's syndrome: a case report. Acta Anaesthesiol Scand. 2004;48:518-20.
Song JY, Rana N, Rottman CA. Laparoscopic appendicectomy in a female patient with situs inversus: case report and literature review. JSLS. 2004;8:175-7.
Pitiakoudis M, Tsaroucha AK, Katotomichelakis M, Polychronidis A, Simopoulos C. Laparoscopic cholecystectomy in a patient with situs inversus using ultrasonically activated coagulating scissors. Report of a case and review of the literature. Acta Chir Belg. 2005;105:114-7.
Rosen H, Petrosyan M, Mason RJ. Cholecystitis in situs inversus totalis. Radiol case reports. 2008;3:226.
Moreli SH, Young L, Reid B, Ruttenberg H, Bamshad MJ. Clinical analysis of families with heart, midline and laterality defects. Am J Med Genet. 2001;101:388-92.
Franklin ME, Almeida JA, Perez ER, Robert LP, Majarrez A. Cholecystectomy and appendectomy by laparoscopy in a patient with situs inversus totalis. A case report and review of the literature. Asoc Mex Cir Endoscopica. 2001;2:150-3.
Carmi R, Roughman J, Rosenbaum K.Human situs determination is probably controlled by several different genes. Am J Med Genet. 1992;44:246-7.
Casey B. Genetics of human situs abnormalities. Am J Med Gene.t 2001;101:356-8.
Nawaz A, Matta H, Hamchou M, Jacobez A, Trad O, Al Salem AH. Situs inversus abdominus in association with congenital duodenal obstruction: A report of two cases and review of the literature. Pediatr Surg Int. 2005;21:589-92.
McDermott JP, Caushaj PF. ERCP and laparoscopic cholecystectomy for cholangitis in a 66-years-old male with situs inversus. Surg Endosc. 1994;8:1227-9.
Rao PG, Katariya RN, Sood S, Rao PLNG: Situsinversustotalis with calculus cholecystitis and mucinous cystadenomas of ovaries. J Postgrad Med. 1977;23:89-90.
Yaghan RJ, Gharaibeh KI, Hammori S. Feasibility of laparoscopic cholecystectomy in situs inversus. J Laparoendosc Adv Surg Tech. 2001;11:233-7.
Winer-Muram HT. Adult presentation of heterotaxic syndromes and related complexes. J Thorac Imaging. 1995;10:43-57.
Cladis FP. Index of Syndromes and their Paediatric Anaesthetic Implications. Etsuro K. Motoyoma, Peter J.Davis. Smith’s Anaesthesia for Infants and Children Philadelphia 2006:1216.