Ann Hepatobiliary Pancreat Surg.  2023 Aug;27(3):322-327. 10.14701/ahbps.22-138.

A rare case report of Mirizzi syndrome type III treatment algorithm in situs inversus totalis, large ventricular septal defect and transposition of great arteries in a young diabetic patient

• Badipati R
• Maity S
• Maddasani M
• Galib Ali SM
• Khatoon FN
• Kasinikota LD
• Gunturu K
• Prameela G

• KMID: 2545781
• DOI: http://doi.org/10.14701/ahbps.22-138

Abstract

Situs inversus totalis (SIT) is a rare condition in which cardiac and abdominal organs are inverted from their normal left-sided orientation. Mirizzi syndrome, characterized by the obstruction of the common hepatic duct or the common bile duct by gallstone, is a rare condition. Mirizzi syndrome co-occurrence in SIT patients is rare. Gallbladder in sinistroposition is extremely uncommon in SIT patients. We report a known case of diabetes, ventricular septal defect with transposition of the great arteries in a 32-year-old female who presented with jaundice, cholangitis, chills, and fever that had lasted for 10 days. She was confirmed to have SIT with type III Mirizzi syndrome following a series of diagnostic procedures. Primarily, endoscopic retrograde cholangiopancreatography along with common bile duct stenting was performed to initially reduce cholangitis. After an eight-week follow-up after the reduction of cholangitis, surgery was conducted. Mirror-imaged ports were used for the laparoscopic procedure, and the surgeon was on the patient’s right side rather than the usual left side. The patient was discharged from the hospital following two days of uneventful healing.

Keyword

Situs inversus totalis; Mirizzi syndrome; Transposition of great arteries; Ventricular septal defect; Laparoscopic cholecystectomy INTR

Figure

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  Fig. 1 Presence of dextrocardia as seen in the chest X-ray.

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  Fig. 2 Presence of gallstone in common bile duct (green arrow represents the gallstone; blue arrow represents the cystic duct; and orange arrow indicates common hepatic duct).

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  Fig. 3 Magnetic resonance imaging of the patient (red circle showing moderate dilation of upper common bile duct).

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  Fig. 4 Placement of stent in common bile duct (CBD).

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  Fig. 5 (A) Gallstone in CBD (visualized during CBD exploration). (B) Pictorial representation of the type of Mirizzi syndrome (type III) seen in the patient. CBD, common bile duct.

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  Fig. 6 (A) Types of Mirizzi syndrome (I–V represent Mirizzi syndrome types I–V). (B) The same types of Mirizzi syndromes present in a patient of situs inversus (seen in inverted position).

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