{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T02:35:52Z","timestamp":1792290952251,"version":"4.4.0"},"reference-count":16,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,4,28]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:p>A multidisciplinary approach is essential for accurately mapping the biliary anatomy and detecting associated anomalies in situs inversus. Imaging modalities such as contrast-enhanced CT, magnetic resonance cholangiopancreatography (MRCP) and preoperative percutaneous transhepatic biliary drainage can aid in delineating complex biliary strictures. The early identification of lesser curvature of stomach to be traced down to the duodenum, using the umbilical fissure to identify gallbladder fossa and careful orientation of the mesentery of the Roux limb of the jejunum towards the umbilical fissure are key strategies for stricture repair.<\/jats:p>\n                  <jats:p>\n                    Postcholecystectomy benign biliary stricture in the presence of situs inversus is a surgical challenge due to the complexity added by inversion of anatomical landmarks. In this report, we present the challenges to be anticipated during stricture repair and the ways to navigate them. We also suggest alternate port placement to ensure safe cholecystectomy in situs inversus (\n                    <jats:italic>si<\/jats:italic>\n                    ).\n                  <\/jats:p>\n                  <jats:p>We also emphasise higher imaging like MRCP before cholecystectomy in situs inversus, to be fully aware of a possible variant biliary anatomy, as a bile-duct injury in the background of situs inversus makes stricture repair complicated.<\/jats:p>","DOI":"10.1136\/bcr-2025-271040","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T06:30:13Z","timestamp":1779172213000},"page":"e271040","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Navigating postcholecystectomy Bismuth type V benign biliary stricture in situs inversus: challenges in repair and prevention"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7567-338X","authenticated-orcid":false,"given":"Krishna Rao","family":"Gurana","sequence":"first","affiliation":[{"name":"Department of Hepato Pancreato Biliary Surgery, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anoop","family":"Paul","sequence":"additional","affiliation":[{"name":"Department of Hepato Pancreato Biliary Surgery, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siddharth M","family":"Babu","sequence":"additional","affiliation":[{"name":"Department of Hepato Pancreato Biliary Surgery, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1958-665X","authenticated-orcid":false,"given":"Gilbert Samuel","family":"Jebakumar","sequence":"additional","affiliation":[{"name":"Department of Hepato Pancreato Biliary Surgery, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sudeept","family":"Kanungo","sequence":"additional","affiliation":[{"name":"Department of Hepato Pancreato Biliary Surgery, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santosh Babu","family":"Kannan Bharathy","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shobiga","family":"Natarajan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harish","family":"Iswaria","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The Prince Charles Hospital, Chermside, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aparna","family":"Jagannathan Munjurpattu","sequence":"additional","affiliation":[{"name":"Department of Hepato Pancreato Biliary Surgery, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravish Sanghi","family":"Raju","sequence":"additional","affiliation":[{"name":"Department of Hepato Pancreato Biliary Surgery, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Joseph","sequence":"additional","affiliation":[{"name":"Department of Hepato Pancreato Biliary Surgery, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"2026051823300797000_19.5.e271040.1","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijscr.2024.109265","article-title":"Complete Common Bile Duct Injury after Laparoscopic Cholecystectomy in Situs Inversus Totalis: A Case Report, Review of the Literature and Illustrative Case Video","volume":"115","author":"Aburayya","year":"2024","journal-title":"Int J Surg Case Rep"},{"key":"2026051823300797000_19.5.e271040.2","doi-asserted-by":"crossref","DOI":"10.1590\/0102-672020240002e1795","article-title":"Bile duct injury repair in a patient with situs inversus totalis","volume":"37","author":"Meira-J\u00fanior","year":"2024","journal-title":"Arq Bras Cir Dig"},{"key":"2026051823300797000_19.5.e271040.3","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1097\/SLA.0000000000002258","article-title":"Long-term Impact of Bile Duct Injury on Morbidity, Mortality, Quality of Life and Work Related Limitations","volume":"268","author":"Booij","year":"2018","journal-title":"Ann Surg"},{"key":"2026051823300797000_19.5.e271040.4","first-page":"40921930","article-title":"Long-term outcomes and quality of life after repair of benign biliary stricture of post-cholecystectomy bile duct injury","volume":"PMID","author":"Kharel","year":"2025","journal-title":"Indian J Gastroenterol"},{"key":"2026051823300797000_19.5.e271040.5","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.jviscsurg.2019.08.005","article-title":"Outcomes of surgery for post-cholecystectomy bile duct injuries: An audit from a tertiary referral center","volume":"157","author":"Ray","year":"2020","journal-title":"J Visc Surg"},{"key":"2026051823300797000_19.5.e271040.6","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1007\/s12262-013-0880-x","article-title":"Factors Affecting Short-Term and Long-Term Outcomes After Bilioenteric Reconstruction for Post-cholecystectomy Bile Duct Injury: Experience at a Tertiary Care Centre","volume":"77","author":"Bansal","year":"2015","journal-title":"Indian J Surg"},{"key":"2026051823300797000_19.5.e271040.7","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1080\/13651820701883114","article-title":"Complex bile duct injuries: management","volume":"10","author":"de Santib\u00e1\u00f1es","year":"2008","journal-title":"HPB (Oxford)"},{"key":"2026051823300797000_19.5.e271040.8","doi-asserted-by":"crossref","first-page":"1542","DOI":"10.1111\/ans.17047","article-title":"Analysis of outcomes of biliary reconstruction after post-cholecystectomy bile duct injuries","volume":"91","author":"Anand","year":"2021","journal-title":"ANZ J Surg"},{"key":"2026051823300797000_19.5.e271040.9","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1159\/000097894","article-title":"Postcholecystectomy Benign Biliary Strictures \u2013 Long-Term Results","volume":"23","author":"Sikora","year":"2006","journal-title":"Dig Surg"},{"key":"2026051823300797000_19.5.e271040.10","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1007\/s12262-011-0375-6","article-title":"Management of post-cholecystectomy benign bile duct strictures: review","volume":"74","author":"Sikora","year":"2012","journal-title":"Indian J Surg"},{"key":"2026051823300797000_19.5.e271040.11","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-001-0102-8"},{"key":"2026051823300797000_19.5.e271040.12","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.1111\/ans.18281","article-title":"Post cholecystectomy benign biliary stricture-isolated hepatic duct stricture: a proposed modification of the BISMUTH classification","volume":"93","author":"Rymbai","year":"2023","journal-title":"ANZ J Surg"},{"key":"2026051823300797000_19.5.e271040.13","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1002\/ags3.12500","article-title":"Total Hilar Exposure Maneuver for Repair of Complex Bile Duct Injury","volume":"6","author":"Wiboonkhwan","year":"2022","journal-title":"Ann Gastroenterol Surg"},{"key":"2026051823300797000_19.5.e271040.14","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1080\/08941939.2019.1622822","article-title":"A Systematic Review of Laparoscopic Cholecystectomy in Situs Inversus","volume":"34","author":"Chaouch","year":"2021","journal-title":"J Invest Surg"},{"key":"2026051823300797000_19.5.e271040.15","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s13017-021-00369-w","article-title":"2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy","volume":"16","author":"de\u2019Angelis","year":"2021","journal-title":"World J Emerg Surg"},{"key":"2026051823300797000_19.5.e271040.16","doi-asserted-by":"crossref","DOI":"10.1186\/s12893-025-02847-3","article-title":"The difficult laparoscopic cholecystectomy: a narrative review","volume":"25","author":"Abdallah","year":"2025","journal-title":"BMC Surg"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-271040","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T06:30:15Z","timestamp":1779172215000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-271040"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":16,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,18]]},"published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1136\/bcr-2025-271040"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-271040","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]}}}