Flipped Anatomy, Same Pain: Rare Case of Acute Cholecystitis with Mucocele in Situs Inversus Totalis

Situs inversus totalis (SIT) is a rare congenital anomaly with an incidence of approximately 1 in 10,000 individuals. It is more prevalent in males than females, with a ratio of 1.5:1, and has no known racial predilection (1,2). While SIT is typically asymptomatic, it can pose diagnostic challenges in conditions such as cholecystitis and appendicitis due to the transposition of internal organs, leading to symptoms manifesting on the contralateral side. This report presents the case of a 46-year-old female who presented to the emergency department with colicky pain localized to the left upper quadrant, accompanied by bilious vomiting and fever. Abdominal ultrasonography revealed situs inversus totalis with acute cholecystitis associated with mucocele. The patient underwent a laparoscopic cholecystectomy. Laparoscopic cholecystectomy in patients with SIT presents technical challenges due to the mirror-image arrangement of abdominal structures. Surgeons must modify their standard approach by strategically planning the placement of trocars to facilitate a successful procedure. Key words: Situs inversus totalis; Acute cholecystitis; cholelithiasis; Mucocele of gallbladder; laparoscopic Cholecystectomy.