Patient With Situs Inversus Stabbed In The Right Flank

Abstract

A situs inversus is a congenital condition in which the positions of the major visceral organs are reversed. This autosomalrecessive genetic condition can be X-linked or found in identical twins. The frequency of situs inversus varies among different populations: it is less than 1 in 10 000 people, with a 5-10% prevalence of congenital heart disease, most commonly transposition of great vessels. The incidence of congenital heart disease is 95% in situs inversus with levocardia. Here we present a 29-year-old male who was admitted in the Surgical Ward, Vryheid Hospital, Kwazulu Natal Province, for suffering from a right flank stab in the abdomen. Dextrocardia was confirmed after doing a physical examination and a preoperative chest xray. The patient suffered from a septic shock and he needed to be resuscitated. Laparotomy revealed situs inversus (with appendix and liver lying on the left side of the abdomen, stomach and sigmoid colon on the right side), generalized peritonitis due to a perforated small-bowel loop and a sigmoid mesentery laceration. Evacuation of peritonitis, resection of perforated bowel, end-to-end anastomosis in two layers with Vicryl 2/0, placement of a suction drain (6mm) and wash-out with saline solution were done as operative procedures. The patient’s postoperative evolution was good and uneventful and he was discharged on the eighth postoperative day. The recognition of situs inversus is important for preventing surgical mishaps that result from the failure to recognize the reversed anatomy or an atypical history.