Laparoscopic management of splenic infarct in polysplenia with situs inversus – Case report and review literature

ABSTRACT: Situs inversus totalis (SIT) is a rare congenital abnormality, characterised by mirror imaging of visceral organs. Polysplenia is a subset of this, where multiple splenules are present. Splenic infarcts, in such conditions, can cause diagnostic uncertainty and significant surgical challenge. We report a case of a 35-year-old male with SIT and polysplenia who presented with right upper abdominal pain, fever and vomiting. Imaging showed multiple splenules in the right hypochondrium, with a peripheral splenic infarction. Laparoscopic splenectomy was done with modified port placement to accommodate the reversed anatomy. Laparoscopic splenectomy in patients with SIT and polysplenia is technically challenging due to altered anatomy and the need for a reversed surgical approach. Although technically demanding, it can offer better visualisation over an open approach. To the best of our knowledge, this is the first reported case of laparoscopic management for splenic infarction in polysplenia with SIT. The laparoscopic approach, though quite challenging, can be made feasible in such cases with effective planning but only under the expertise who can adapt to intra-operative challenges.