Our experience with surgery in situs inversus: Open peptic perforation repair and laparoscopic cholecystectomy in 1 patient and 3 patients respectively
| Autor: | Sanjeev Chhabra, Shalu Gupta, Devender Talera, Rajendra Prasad Bugalia, Raj Kamal Jenaw, Nitin Kumar, Bhanwar Lal Yadav, Amit Goyal, Dhananjay Saxena, Sami Anwar Khan, Jeevan Kankaria, Rahul Yadav, Zeeshan Ahmed, Vikesh Vij |
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| Jazyk: | angličtina |
| Předmět: |
medicine.medical_specialty
congenital hereditary and neonatal diseases and abnormalities medicine.medical_treatment Peptic Axillary lines Peritonitis Costal margin Omentopexy 03 medical and health sciences Laparoscopic cholecystectomy 0302 clinical medicine medicine otorhinolaryngologic diseases Case Series business.industry General surgery food and beverages medicine.disease Perforation peritonitis Surgery Situs inversus medicine.anatomical_structure 030220 oncology & carcinogenesis Cholecystitis 030211 gastroenterology & hepatology business |
| Zdroj: | International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| DOI: | 10.1016/j.ijscr.2016.10.035 |
| Popis: | Highlights • Surgical diagnosis of conditions causing acute abdominal pain in situs inversus is complicated by the mirror image anatomy. • Chest X-ray and Ultrasonography abdomen can be helpful in diagnosing this condition. • Laparoscopic cholecystectomy in situs inversus is problematic for right handed surgeons. • We describe a modified 4 port configuration where right handed surgeons can use the left mid-clavicular port for dissection. Introduction Situs inversus is a rare autosomal recessive condition associated with complete transposition of abdominal +/− thoracic organs. Surgical diagnosis and surgical procedures in patients with situs inversus is tricky because of the mirror image anatomy of intra-abdominal organs. Materials and methods A retrospective analysis of 2152 and 1497 patients who underwent laparoscopic cholecystectomy and open peptic perforation repair respectively from June 2014-June 2016 was done. 1 patient and 3 patients with situs inversus underwent open peptic perforation repair and laparoscopic cholecystectomy respectively. A 10 mm left para-median port 5 cm caudally from xiphoid was used for grasping the infundibulum. Two 5 mm ports placed 10 cm caudally from costal margin in the mid-clavicular and anterior axillary line were used for dissecting and retracting fundus respectively. A 10 mm supra-umbilical camera port was used. Results A 40 year male with situs inversus totalis underwent open peptic perforation repair. Laparoscopic cholecystectomy was done in 3 female patients with situs inversus aged 33–46 year (mean 41 year). Mean operative time for laparoscopic cholecystectomy was 59 min (39–93). There were no intraoperative or post-operative complications. Histopathology revealed chronic inflammation in peptic perforation and cholecystitis. Conclusion Perforation peritonitis in situs inversus can cause diagnostic confusion with free gas under the left hemi diaphragm. Laparoscopic cholecystectomy in situs inversus is ergonomically inconvenient and technically difficult for right handed surgeons. We describe an ergonomically convenient port placement for right handed surgeons in situs inversus. |
| Databáze: | OpenAIRE |
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