Situs Inversus Totalis Patient Research Articles

Coronary artery bypass grafting in a patient with situs inversus totalis: a case report

BackgroundCoronary artery bypass grafting in situs inversus totalis patients has been seldom reported in the literature.Case presentationA 76-year-old woman visited our hospital for chest pain and dyspnea that had started about 5 years earlier. Coronary angiography revealed triple-vessel disease, and computed tomography showed situs inversus totalis. Coronary artery bypass grafting was performed. In this case, the main operating surgeon stood on the right side of the patient until cardiopulmonary bypass was established and then switched positions to the left side of the patient for anastomosis.ConclusionCABG was successfully completed in a patient with situs inversus totalis. The position shift helped improve the safety and ease of the surgery.

Spleen preserving distal pancreatectomy in a situs inversus totalis patient

Purpose: Solid pseudopapillary tumor (SPT) of the pancreas is an uncommon neoplasm with a low malignant potential that generally occurs in young women. Surgical resection is the gold standard treatment for this entity. When possible, laparoscopic resection is advisable. We present the case of a 26 years old patient with situs inversus totalis diagnosed with a SPT located in the tail of the pancreas. Methods: A 25-year-old woman presented after being study for renal pain and incidentally finding a distal pancreatic mass. CT-Scan showed a rounded hypodense mass of 25 mm located in the tail of the pancreas and a situs inversus totalis. None laboratory alteration was founded. Histology by USE confirmed the presence of a solid pseudopapillary tumor. A laparoscopic distal spleen preserving pancreatectomy was proposed. Results: The usual trocar position was changed like a mirror and the surgeon was located between the patient's legs. The first visualization showed a complete inverted position of all abdominal organs. An extra 5 mm trocar was used to remove the gallbladder due to stones and recurrent upper right quadrant pain. The cystic duct and artery had to be dissected with the left hand to be able to dissect from medial to lateral. Completion of cholecystectomy did not present any extra complexity. After opening the lesser omentum, an intraoperative ultrasonography of the pancreas was performed that showed a hypoechogenic mass on the tail of the pancreas located on the right of the patient. The splenic artery and vein were dissected and were also in a mirror position. The dissection of the superior border of the pancreas, as well as the splenic artery, resulted easy as the right hand was straightforward while splenic vein dissection that was very encircled in the posterior face of the pancreas resulted in an increased difficulty. After the division of these vessels and the neck of the pancreas, spleen preserving distal pancreas were completed as usual. The patient was discharged on the 5 th postoperative day with drainage after a biochemical pancreatic leakage. Conclusion: Despite technical difficulties when operating situs inversus totalis patients, laparoscopic spleen preserving pancreatectomy is a safe and feasible technique.

TRANSHIATAL DISTAL ESOPHAGECTOMY AND TOTAL GASTRECTOMY IN A CASE OF ESOPHAGOGASTRIC TUMOUR WITH SITUS INVERSUS TOTALIS

Situs inversus totalis (SIT) is a rare congenital anomaly with a thoracic cavity, and abdominal structures are reversed. The most suitable approach and surgical technique in a patient with SIT and organ variation remain unclear. We report our experience with a case of situs inversus totalis diagnosed with the esophagogastric tumour. We report a 77 years old female diagnosed with locally advanced esophagogastric tumour classified as Siewert Type II. Preoperative CT scan shows a complete mirror image of the thoracic cavity and abdominal viscera and no vascular anomalies. She underwent distal esophagectomy and total gastrectomy with Roux-en-y anastomosis and D2 lymph node dissection. Distal esophagectomy was done via transhiatal approach for adequate proximal margin resection. There were no intra-operative problems, and the postoperative course was uneventful. Till present, we believe that this is the first case of Transhiatal distal esophagectomy and total gastrectomy in situs inversus totalis patient reported in Malaysia.

Laparoscopic cholecystectomy in a situs inversus totalis patient with acute calculous cholecystitis: a case report

Background: Situs inversus is a rare and silent autosomal recessive disorder occurring in 1:5,000 to 1:20,000 individuals. Laparoscopic cholecystectomy, a standard treatment for gallbladder disease in the general population, is very challenging in patients with situs inversus totalis and acute cholecystitis, especially for right-handed surgeons. We herein report a case involving our modified laparoscopic cholecystectomy technique for right-handed surgeons in a Korean female patient with situs inversus totalis who developed a acute diffuse suppurative calculous cholecystitis. Case presentation: An 83-year-old female patient with dextrocardia presented with a two days history of epigastric and left upper quadrant abdominal pain. Vital signs were stable. White blood cell showed 18,400/uL. C reactive protein was 22.57 mg/dL. Abdominal commputerized tomography revealed a left-sided gallbladder with volumetric increase of the gallbladder and even enhancing thicknesssevere of the gallbladder wall suggesting acute calculous cholecystitis. We performed emergent laparoscopic cholecystectomy with our modified technique including port relocation. The operation went well, and our patient recovered satisfactorily. Conclusion: Laparoscopic cholecystectomy in a patient with a left-sided gallbladder is not often confidently performed by right-handed surgeons. However, some modifications of “mirror image” ports are the keys to successful completion of this operation. The patient will thus still obtain benefits from this standard minimally invasive technique. Keywords: Laparoscopic cholecystectomy, Situs inversus totalis and Acute cholecystitis.

Gastric cancer in a situs inversus totalis patient with multiple intestinal and vessel variations related to gastrectomy surgery: A case report and literature review.

Rationale:Situs inversus totalis (SIT) is a rare congenital anomaly characterized by complete inversion of the abdominal and thoracic organs, and often involves multiple genetic mutations. The most suitable surgical technique for patients with multiple vessel and organ variations as well as SIT remains unclear. Furthermore, there has been insufficient clinical evidence that demonstrates which surgical techniques achieve the best outcomes. Finally, the standard of care has not yet been determined. We present the case of a 60-year-old man with SIT, who was diagnosed with moderately and poorly differentiated adenocarcinoma at the gastroesophageal junction. We further describe the advantage of using robotic-assisted laparoscopic surgery in patients with this anomaly.Patient concerns:A 60-year-old man complained of pain in his upper abdomen for 3 months. Physical examination revealed an apex beat in the right fifth intercostal space, and vascular anomalies were noted on abdominal angiographic computed tomography.Diagnoses:Moderately and poorly differentiated adenocarcinoma at the gastroesophageal junction with SIT.Interventions:Robot-assisted total gastrectomy with D2 lymph node dissection and hand-sewn Roux-en-Y anastomosis was performed.Outcomes:The postoperative course was uneventful, and the patient was discharged on the seventh postoperative day.Lessons:Robotic surgery for gastric cancer is a safe and feasible alternative to laparoscopic surgery and it can be successfully used to treat gastric cancer in patients with SIT with multiple anatomic variations. As exemplified by our case, SIT might be accompanied by multiple anatomic variations. Detailed preoperative detailed imaging of the blood vessels and gastrointestinal tract is useful in these patients.