Surgical Science, 2013, 4, 448-452 http://dx.doi.org/10.4236/ss.2013.410088 Published Online October 2013 (http://www.scirp.org/journal/ss) Alternate Technique for Doing Laparoscopic Cholecystectomy in Situs Inversus * Vikrant Singh 1 , Zahur Hussain 1 , Shadilal Kachroo 1 , Vanita Gupta 2# , Harbinder Singh 1 , Mukesh Kumar 1 , Barinder Kumar 1 1 Government Medical College, Jammu, India 2 Acharya Shree Chander College of Medical Sciences, Jammu, India Email: vikrant1118@rediffmail.com, # doctorvanita@yahoo.co.in Received May 3, 2013; revised June 2, 2013; accepted June 10, 2013 Copyright © 2013 Vikrant Singh et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT A 45-year-old female with known situs inversus totalis presented with left-sided abdominal discomfort. Chest X-ray, abdominal ultrasonography and CT scan confirmed the diagnosis of a gallstone, as well as, situs inversus; Laparoscopic cholecystectomy was safely performed with mirror image of standard 4 ports. Callots triangle dissection was done with epigastric working port by surgeon, but gallbladder fossa dissection was done by surgical assistant from midclavicular port as main working port. Laparoscopic surgeon should be careful for view of reversed relationships and also for exis- tence of other anomalies. Keywords: Situs Inversus Totalis; Laparoscopic Cholecystectomy; Anomalies 1. Introduction Situs inversus is a morphological anomaly of positioning of internal viscera wherein there is a reversal of the usual “handedness” of visceral topography. The reversal may be thoracic, abdominal or both. It is estimated to occur in 1 in 5000 - 20,000 births [1,2]. In the published literature, there have been only about 40 reports of open cholecys- tectomy in the pre-laparoscopic era and 20 reports of laparoscopic cholecystectomy in patients with situs in- versus [2-4]. Although there are many reports of patients with situs inversus and cholelithiasis, there is no evi- dence that the incidence of cholelithiasis is greater in these patients [5]. It has been reported that about a third of patients with situs inversus and symptomatic gall stones may, however, present with epigastric pain and about 10% of patients may present with right-sided pain [6]. 2. Case Report Our patient was a 45-year-old female patient, who had four children. Patient presented with pain left side of abdomen and was been treated with antibiotics and painkillers with no relief, after which ultrasound was done which re- vealed left sided gallbladder with stones in it. Patient had no co-morbidities or anomalies. Chest X-ray showed dextrocardia consistent with situs inversus but there was no evidence of Bronchiectasis (Figure 1). CECT showed situs inversus with Cholelithiasis (Fig- ure 2). * The work was conducted in Department of Surgery, Government Medical College Jammu, J & K. # Corresponding author. Figure 1. Chest X-ray showing dextrocardia consistent with situs inversus. Copyright © 2013 SciRes. SS