Pancreaticoduodenectomy for biliary tract carcinoma with situs inversus totalis: difficulties and technical notes based on two cases

Daisuke Kyuno,Masafumi Imamura,Motonobu Uchiyama,Yasutoshi Kimura,Makoto Meguro,Masayuki Ishii,Koichi Hirata,Masaki Kawamoto,Toru Mizuguchi

doi:10.1186/1477-7819-11-312

Daisuke Kyuno, Masafumi Imamura + Show 7 more

Open Access

https://doi.org/10.1186/1477-7819-11-312

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Abstract

Situs inversus totalis (SIT) denotes complete right-left inversion of the thoracic and abdominal viscera. Diagnosis and surgical procedures for abdominal pathology in patients with SIT are technically more complicated because of mirror-image transposition of the visceral organs. Moreover, SIT is commonly associated with cardiovascular and hepatobiliary malformations, which make hepatobiliary-pancreatic surgery difficult. Two cases of pancreaticoduodenectomy for biliary tract carcinoma in patients with SIT are presented. Both patients had an anomaly of the hepatic artery. Advanced diagnostic imaging techniques were very important for careful preoperative planning and to prevent misunderstanding of the arrangement of the abdominal viscera. This facilitated the surgical team’s adaptation to the mirror image of the standard procedure and helped avoid intraoperative complications due to cardiovascular and hepatobiliary malformations associated with SIT. Pancreaticoduodenectomy in patients with SIT can be performed successfully with detailed preoperative assessment, use of effective techniques by the surgeon, and appropriate support by assistants.

Highlights

Situs inversus totalis (SIT) is characterized by a left-toright reversal of the abdominal viscera with dextrocardia
The exact etiology of SIT remains unknown, SIT is thought to result from chromosomal abnormalities that lead to a reversal of right-left polarity [2,3,4]
Each surgical procedure was performed while encircling the major vessels (the superior mesenteric vein (SMV), portal vein (PV), common hepatic artery (CHA), gastroduodenal artery (GDA), proper hepatic artery (PHA), and the right and left hepatic arteries) with tapes

Summary

Introduction

Situs inversus totalis (SIT) is characterized by a left-toright reversal of the abdominal viscera with dextrocardia. This is in contrast with situs inversus viscerum ( termed situs inversus, SI), which means a complete mirror-image transposition of the abdominal visceral organs with normal orientation of the thoracic organs. Previous authors have reported performing pancreaticoduodenectomy in patients with SI or SIT [10,11,12,13,14,15] They reported that the surgical procedures were difficult because of the anatomical abnormalities and that special attention should be paid to diagnosis and preoperative staging. Taking into account experience with past cases of successful pancreaticoduodenectomy for biliary tract carcinoma with SIT, this report focuses on the difficulties and technical notes of pancreaticoduodenectomy in patients with SIT

Methods

Discussion

Conclusion