Key Words: coledocolitiasis, situs Inversus, colelitiasis
Abstract
Situs inversus totalis (SIT) is a rare condition, in which there is transposition of the thoraco-abdominal organs. This situation leads to diagnostic and therapeutic difficulties in patients with acute surgical abdomen. The objective of this report is to present the case of a patient who presented with colonic pain in the epigastrium and left hypochondrium, in which the diagnosis of SIT, cholelithiasis and choledocholithiasis was reached after the respective imaging studies. Once the diagnosis was made, treatment was performed through retrograde endoscopic cholangiopancreatography (ERCP) and subsequent surgical exploration of bile ducts. Both procedures were failed due to technical difficulties generated by the patient's condition. In conclusion, in spite of the report of successful cases in the literature of ERCP and surgical treatment of the biliary tract in SIT, there may be situations that do not allow a successful approach, so meticulous surgical planning and the use of support methods are necessary In the management of these patients
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El situs inversus totalis es una rara condición en la que existe trasposición de los órganos torácicos abdominales. Esta situación da lugar a dificultades diagnósticas y terapéuticas en pacientes con cuadros de abdomen agudo quirúrgico. El objetivo de este reporte es dar cuenta del caso de un paciente que presentó con dolor de tipo cólico en epigastrio e hipocondrio izquierdo. Luego de los estudios imagenológicos del caso, el paciente fue diagnosticado como situs inversus totalis, con colelitiasis y coledocolitiasis. El tratamiento fue realizado mediante una colangiopancreatografía retrograda endoscópica y posterior exploración quirúrgica de vías biliares. Ambos procedimientos fueron fallidos, debido a dificultades técnicas generadas por la condición del paciente. En conclusión, pese al reporte de casos exitosos en la literatura de colangiopancreatografía retrograda endoscópica y tratamiento quirúrgico de la vía biliar en situs inversus totalis, pueden existir situaciones que no permitan un abordaje exitoso. Es por ello que una planificación quirúrgica meticulosa y el uso de métodos de apoyo son necesarios en el manejo de estos pacientes.
Autores:
Jerson Francisco Morales-Rodríguez[1], Estefania Corina Cotillo[2], Oscar Moreno-Loaiza[3]
Affiliation:
[1] Departamento de Cirugía, Hospital Carlos Alberto Seguín Escobedo, Arequipa, Perú
[2] Facultad de medicina, Universidad Andina Néstor Cáceres Velásquez, Puno, Perú
[3] Facultad de Medicina, Universidad Nacional San Agustín, Arequipa, Perú
E-mail: oscarml5@hotmail.com
Author address:
[1] Urbanización Villa Gloria 4 f-7
Arequipa
Perú
Citation: Morales-Rodríguez JF, Corina Cotillo E, Moreno-Loaiza O. Surgical treatment of choledocholithiasis in a patient with situs inversus totalis: a case report and literature review. Medwave 2017 Jul;17(6):e7002 doi: 10.5867/medwave.2017.06.7002
Submission date: 24/4/2017
Acceptance date: 8/7/2017
Publication date: 31/12/1969
Origin: no solicitado
Type of review: con revisión por tres pares revisores externos, a doble ciego
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- Navarro V, Oshiro H, Peña B, Moquillaza Pineda F. [Situs inversus totalis]. Rev Gastroenterol Peru. 2013 Oct-Dec;33(4):345-7. | PubMed |
- Machado NO, Chopra P. Laparoscopic cholecystectomy in a patient with situs inversus totalis: feasibility and technical difficulties. JSLS. 2006 Jul-Sep;10(3):386-91. | PubMed |
- Sena R, Weiss M, Abreu A, Costa L, Peixoto R, Gomes C, et al. Laparoscopic Cholecystectomy in Patient with Situs Inversus Totalis: Diagnostic and Treatment Pitfalls. Arch Clin Exp Surg. 2016;5(2): 124-127. | CrossRef |
- Hu Y, Zeng H, Pan XL, Lv NH, Liu ZJ, Hu Y. Therapeutic endoscopic retrograde cholangiopancreatography in a patient with situs inversus viscerum. World J Gastroenterol. 2015 May 14;21(18):5744-8. | CrossRef | PubMed |
- Castro DJ, De Faria A. Case study of a sphincterotomy to remove stones from the common bile duct cholelithiasis biliary in a patient with total situs inversus. Rev Colomb Gastroenterol. 2013;28(2):146-8. | Link |
- Melchor-González JM, Pérez-García R, Torres-Vista M, Rodríguez-Brambila VR. Situs inversus. Reporte de dos casos. Cir Ciruj. 2000;68(2):72-75. | Link |
- Çoban Ş, Yüksel I, Küçükazman M, Başar Ö. Successful ERCP in a patient with situs inversus. Endoscopy. 2014;46 Suppl 1 UCTN:E222. | CrossRef | PubMed |
- Vega CGR, Salazar BMA, Calderón JR, Preciado BCY, Heredia JNM, Gandarilla JS. Litiasis vesicular y situs inversus totalis resueltos por cirugía endoscópica con asistencia acuscópica. Rev Mex Cir Endoscop. 2003;4(3):153-161. | Link |
- Reddy A, Paramasivam S, Alexander N, Abhilash, Ravisankar V, Thillai M. Management of a patient with situs inversus totalis with acute cholecystitis and common bile duct stones: A case report. Int J Surg Case Rep. 2014;5(11):821-3. | CrossRef | PubMed |
- Salama IA, Abdullah MH, Houseni M. Laparoscopic cholecystectomy in situs inversus totalis: Feasibility and review of literature. Int J Surg Case Rep. 2013;4(8):711-5. | CrossRef | PubMed |
Navarro V, Oshiro H, Peña B, Moquillaza Pineda F. [Situs inversus totalis]. Rev Gastroenterol Peru. 2013 Oct-Dec;33(4):345-7. | PubMed |Machado NO, Chopra P. Laparoscopic cholecystectomy in a patient with situs inversus totalis: feasibility and technical difficulties. JSLS. 2006 Jul-Sep;10(3):386-91. | PubMed |Sena R, Weiss M, Abreu A, Costa L, Peixoto R, Gomes C, et al. Laparoscopic Cholecystectomy in Patient with Situs Inversus Totalis: Diagnostic and Treatment Pitfalls. Arch Clin Exp Surg. 2016;5(2): 124-127. | CrossRef |Hu Y, Zeng H, Pan XL, Lv NH, Liu ZJ, Hu Y. Therapeutic endoscopic retrograde cholangiopancreatography in a patient with situs inversus viscerum. World J Gastroenterol. 2015 May 14;21(18):5744-8. | CrossRef | PubMed |Castro DJ, De Faria A. Case study of a sphincterotomy to remove stones from the common bile duct cholelithiasis biliary in a patient with total situs inversus. Rev Colomb Gastroenterol. 2013;28(2):146-8. | Link |Melchor-González JM, Pérez-García R, Torres-Vista M, Rodríguez-Brambila VR. Situs inversus. Reporte de dos casos. Cir Ciruj. 2000;68(2):72-75. | Link |Çoban Ş, Yüksel I, Küçükazman M, Başar Ö. Successful ERCP in a patient with situs inversus. Endoscopy. 2014;46 Suppl 1 UCTN:E222. | CrossRef | PubMed |Vega CGR, Salazar BMA, Calderón JR, Preciado BCY, Heredia JNM, Gandarilla JS. Litiasis vesicular y situs inversus totalis resueltos por cirugía endoscópica con asistencia acuscópica. Rev Mex Cir Endoscop. 2003;4(3):153-161. | Link |
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