Endoscopic Sphincterotomy and Laparoscopic Cholecystectomy for Cholecysto-Choledocholithiasis in a Patient with Situs Inversus Totalis: A Case Report

Hiroshi Kawasaki, Tsukasa Nishida, Kenji Umemoto, Kazuhiro Miyoshi, Mitsuru Matsuki*, Yuki Inada* and Takashi Ishibasi

Department of Gastroenterological Surgery and Department of Radiology*, Shiroyama Hospital

A 72-year-old male presented to our emergency room complaining of epigastralgia. Physical examination revealed jaundice and mild epigastric tenderness. Laboratory studies revealed a serum total bilirubin level of 4.6 mg/dl, serum GOT of 699 IU/l, serum GPT of 477 IU/l, and a WBC count of 10,400 /μl. A diagnosis of cholecysto-choledocholithiasis and cholecystitis with situs inversus totalis (SIT) was made, because the chest X-ray revealed dextrocardia and abdomial computed tomography (CT) showed complete transposition of the abdominal viscera. The patient was admitted and started on antibiotics. The day after admission, endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and basket extraction of the multiple common bile duct stones was undertaken. Three dimensional (3D) CT revealed a right-left reversal of the biliary and vascular system without other additional anomalies. The following day, laboratory test results remained within normal limits, therefore, laparoscopic cholecystectomy (LC) was performed. The operation could be safely performed with the surgeon standing on the right side of the patient. The insertion sites for the trocars were prepared in reference to the 3D-CT images, and the operation was performed with the right hand using the double-hand technique. This is the first case in Japan, based on a thorough search of the literature search of LC after ERCP with sphincterotomy for cholecysto-choledocholithiasis in a patient with SIT.

Key words
situs inversus totalis, laparoscopic cholecystectomy, endoscopic sphincterotomy

Reprint requests
Hiroshi Kawasaki Department of Gastroenterological Surgery, Shiroyama Hospital
2-8-1 Habikino, Habikino, 583-0872 JAPAN

Accepted
April 23, 2008

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