Abstract
Situs inversus totalis is the mirror image of situs solitus, the normal position of abdominal and thoracic viscera. Many associated intraabdominal anomalies have been described with this condition. However, association of choledochal cyst with situs inversus has never been reported. Diagnosis and surgical procedures for abdominal pathology in patients with situs inversus totalis are technically more complicated and pose unique challenges because of left-right transposition of the visceral organs. The choledochal cyst is usually diagnosed in the neonatal period or during childhood. The clinical symptoms are nonspecific and usually include pain in the right upper quadrant and jaundice. The condition may also present with biliary colic, cholangitis, cholelithiasis or pancreatitis. In our case, the abdominal ultrasonography performed on a 55-year-old female who presented to us with jaundice, fever and pain in the left upper abdomen revealed presence of situs inversus with fusiform dilation of the common bile duct. Based on the magnetic resonance cholangiopancreatography (MRCP) images diagnosis of type I choledochal cyst was made. The aim of this case report is to illustrate an extremely rare association of situs inversus totalis with choledochal cyst along with the challenges faced in diagnosis and surgical management of this condition.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Blegen HM (1949) Surgery in situs inversus. Ann Surg 129:244–259
Mayo CW, Rice RG (1949) Situs inversus totalis; a statistical review of data on 76 cases with special reference to disease of the biliary tract. Arch Surg 58:724–730
Lee SE, Kim HY, Jung SE, Lee SC, Park KW, Kim WK (2006) Situs anomalies and gastrointestinal abnormalities. J Pediatr Surg 41:1237–1242
McDermott JP, Caushaj PF (1994) ERCP and laparoscopic cholecystectomy for cholangitis in a 66-year-old male with situs inversus. Surg Endosc 8:1227–1229
Fiocca F, Donatelli G, Ceci V, Cereatti F, Romagnoli F, Simonelli L et al (2008) ERCP in total situs viscerum inversus. Case Rep Gastroenterol 2:116–120
Fulcher AS, Turner MA (2002) Abdominal manifestations of situs anomalies in adults. Radiographics 22:1439–1456
Gagner M, Munson JL, Scholz FJ (1991) Hepatobiliary anomalies associated with polysplenia syndrome. Gastrointest Radiol 16:167–171
Ouaissi M, Kianmanesh R, Ragot E, Belghiti J, Wildhaber B, Nuzzo G et al (2016) Congenital bile duct cyst (BDC) is a more indolent disease in children compared to adults, except for Todani type IV-A BDC: results of the European multicenter study of the French Surgical Association. HPB: the official journal of the International Hepato Pancreato Biliary Association 18(6):529–539
Park SW, Koh H, Oh JT, Han SJ, Kim S (2014) Relationship between anomalous pancreaticobiliary ductal union and pathologic inflammation of bile duct in choledochal cyst. Pediatr Gastroenterol Hepatol Nutr 17(3):170–177
Gadelhak N, Shehta A, Hamed H (2014) Diagnosis and management of choledochal cyst: 20 years of single center experience. World J Gastroenterol 20(22):7061–7066
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Redundant or Duplicate Publication
No
Presentation at a Meeting
None
Conflict of Interest
The authors declare that they have no conflicts of interest.
Ethical Approval
Obtained by institutional ethical committee
Patient’s Consent
Obtained
Copyright Assignment
Yes
Source(s) of Support
Nil
Rights and permissions
About this article
Cite this article
Maurya, A.P., Kumar, S., Gupta, V. et al. Management of Complicated Choledochal Cyst in an Adult with Situs Inversus Totalis: Diagnostic Difficulties and Technical Notes. Indian J Surg 79, 464–467 (2017). https://doi.org/10.1007/s12262-017-1613-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12262-017-1613-3