Complete Common Bile Duct Injury after Laparoscopic Cholecystectomy in Situs Inversus Totalis: A Case Report, Review of the Literature and Illustrative Case Video

• Published in: International journal of surgery case reports 2024-02, Vol.115, p.109265, Article 109265
• Main Authors: Aburayya, Bahaa I., Obeidat, Layan R., Kitana, Farah I., Al Khatib, Omar, Romman, Saleh, Hamed, Osama H.
• Format: Article
• Language: English
• Subjects: Case Report; Common Bile Duct Injury; Hepaticojejunostomy; Laparoscopic Cholecystectomy; Situs Inversus Totalis
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2024.109265

Situs Inversus Totalis (SIT) is a rare condition characterized by the transposition of internal organs. Given the anatomical variations in SIT, surgeons must exercise extreme caution when performing laparoscopic cholecystectomy to avoid iatrogenic bile duct injury. Despite the high difficulty index associated with laparoscopic cholecystectomy in SIT, there is only one case report of common bile duct (CBD) injury in the English-language literature. A 41-year-old female patient, known to have Kartagener syndrome, underwent laparoscopic cholecystectomy for acute cholecystitis and was discharged home on post-operative day one. However, on post-operative day five, the patient presented to the emergency room with abdominal pain, fever, and jaundice. Laboratory tests revealed leukocytosis and hyperbilirubinemia. Radiological images revealed complete occlusion of the CBD. A delayed approach was chosen, and six weeks after her initial operation, a hepaticojejunostomy was performed. Laparoscopic cholecystectomy is the standard operative procedure for gallbladder disease. The unique anatomy of SIT increases the risk of CBD injury during laparoscopic cholecystectomy. Surgeons are required to perform a mirror-image procedure and adhere to the basic principles of safe laparoscopic cholecystectomy in SIT. This is only the second reported case of CBD injury in SIT patients. Laparoscopic cholecystectomy in SIT presents a significant challenge. In patients with SIT, preventing CBD injury is the best approach, and referral to an experienced hepato-pancreato-biliary (HPB) surgeon is recommended. A delayed approach to CBD injuries in SIT allows thorough planning and understanding of the complex anatomical variations in these patients. •Situs Inversus Totalis poses a challenge for practicing surgeons during laparoscopic cholecystectomy due to anatomical variations.•The risk of iatrogenic common bile duct injury in SIT increases during acute surgical conditions such as acute cholecystitis.•Radiological investigations should be implemented if common bile duct injury is suspected•Prevention of CBD injuries is considered the best approach and referral to an experienced Hepato-pancreato-biliary surgeon is recommended.•A delayed approach to repairing common bile duct injuries in patients with Situs Inversus Totalis via hepaticojejunostomy is advised.