Left sided gallbladder and liver without situs inversus and recurrent sigmoid volvulus after alleged previous total sigmoid resection; a case report and review of literatures.

INTRODUCTION AND IMPORTANCE: Acute abdomen is an emergency condition which necessitates urgent management. Obstruction accounts to the majority of causes of acute abdomen. As acute abdomen can lead to a dramatic and fatal complication, rapid diagnosis and management are utterly important. Sigmoid volvulus is the commonest cause of large bowel obstruction in Africa and particularly in Ethiopia. Left side gallbladder and liver without situs inversus is a very rare clinical finding with few reports in the history of literatures.

CASE PRESENTATION: A 53 years old male patient presented to our emergency department with failure to pass feces and flatus of 6 days duration. He had similar four episodes previously and sigmoid resection-anastomosis was done five years back at a referral hospital. The abdomen was distended to drum like appearance with visible peristalsis and midline previous surgical scar. The distension is more prominent to right upper quadrant resembling a bent inner tube. Upon entering the abdomen, there was 360 degrees clockwise volvulated remnant sigmoid and descending colon. There was small bowel adhesion to abdominal wall which snugs the large bowel at the neck of volvulus. The liver and gallbladder are on the left upper quadrant and right upper quadrant of abdomen is empty. The gallbladder is to the left of the round/falciform ligament.

CLINICAL DISCUSSION: Intestinal obstruction is one of the commonest causes of acute abdomen carrying significant mortality if not intervened timely. Sigmoid volvulus is one of the common causes of large bowel obstruction more happening in the adults and elderly. It is reported that patients with megacolon and mega rectum have risk of recurrence of volvulus even after sigmoid resection. Left side gallbladder without situs inversus is a very rare occurrence and very few reports in the literature to date.

CONCLUSION: Optimal sigmoid resection in sigmoid volvulus and subtotal colectomy when sigmoid volvulus is associated with megacolon and megacolon are said to reduce postoperative volvulus recurrence. Special care and workup should be a priority during cholecystectomy in left-sided gallbladder to avoid biliary tract and vascular injury.