Situs Viscerum Inversus Totalis Research Articles

Matching the opposites: liver transplantation from a situs viscerum inversus totalis donor.

Situs viscerum inversus totalis (SIT) is a rare congenital anomaly. Deceased donors with this condition are often declined because of the technical issues in both the organ's procurement and its transplant. Only eight cases of deceased donor organs with SITwere reported to be used for liver transplantation (LT). We herein present a case of LT using a graft from an SIT donor: a modified retroversus piggyback technique was used. A 15year-old female was referred to our institution as a potential donor. An SIT condition was discovered during standard donor evaluation together with the presence of a complex triple arterial pedicle. Procurement operative time was 125min, from skin incision to cross-clamp. Liver extraction occurred 32min after cold flush. The recipient was a 56year-old male affected by recurrent hepatocellular carcinoma (HCC) on hepatitis C related liver cirrhosis. Position and orientation trials of the graft were made and it was decided to implant it with the retroversus technique. Direct duct-to-duct biliary reconstruction was achieved. The postoperative course was uneventful. To our knowledge, this is the first implant with retroversus technique combined to direct biliary reconstruction and the first repetition of that technique. Cases like this highlight how technical complexity can be overcome leading to successful management of difficult scenarios in a safe manner.

An unknown situs viscerum inversus totalis, accidentally discovered after computed tomography

Benign situs inversus totalis of the viscerum is often diagnosed accidentally, rarely in adults, and more frequently in children and neonates, affecting both sexes. In this report, a young female patient accidentally discovered a situs inversus totalis after computed tomography for acute abdominal pain. In this uncommon anatomical abnormality, the major visceral organs are reversed in the opposite direction. This report highlights the importance of being aware of and considering situs inversus in clinical practice, particularly when interpreting imaging findings and planning medical procedures. This is critical for differential diagnosis and comorbidities that may affect those patients. The cause of situs inversus totalis is still unknown; however, this condition is frequently asymptomatic, particularly in infants, and is sometimes associated with other syndromes. The patient arrived at the emergency department with left flank pain, nausea, and fever. In the first ultrasonography, a strange anatomy was suspected; thus, a contrasted computed tomography was performed. The patient had never had a computed tomography scan before. The identification of situs inversus totalis was unexpected and coincidental; the computed tomography images were carefully examined. In patients with chest or abdominal pain, clinicians may consider situs inversus totalis based on computed tomography, particularly if without clinical and imaging history. This knowledge can help in the differential diagnosis, avoiding unneeded interventions. Moreover, comorbidities that affect several systems, particularly cardiovascular and pulmonary systems, affect quite a few patients with situs inversus totalis, who require careful examination and lifelong monitoring.

Multivessel coronary artery disease in a patient with situs viscerum inversus totalis: a case report

Multivessel coronary artery disease in a patient with situs viscerum inversus totalis: a case report

Laparoscopic cholecystectomy with indocyanine green fluorescence in patient with situs inversus totalis

Situs Viscerum Inversus (SVI) is a rare autosomal recessive disease. Because of this particular anatomy, it could be challenging for the surgeon to perform any abdominal procedure, including laparoscopic cholecystectomy. In these situations, indocyanine green fluorescence cholangiography can be essential. A 29-year-old female with documented situs viscerum inversus totalis underwent laparoscopic cholecystectomy with a four-trocar technique. Switching the vision to the near-infrared camera, which elicited the indocyanine green molecules, the surgeon could easily identify the common bile duct and the cystic duct. Switching back to the normal vision, the operator completed the dissection. The described procedure is still challenging due to the “mirror effect” and the uncommon position of the surgical instruments, especially for right-handed surgeons. Indocyanine green fluorescence angiography can help the surgeon identify the structures in cases of non-regular anatomy such as this.

Laparoscopic Cholecystectomy with a Mixed Approach in a Patient with Kartagener Syndrome: Technical Report and Review of Literature

Kartagener syndrome (KS) is a rare autosomal recessive disease. The disease is characterized by three typical symptoms: chronic sinusitis, situs viscerum inversus (SVI), and bronchiectasis. The laparoscopic cholecystectomy (LC) is the standard procedure in most cases of cholelithiasis, but in SVI patients it can be difficult, especially for right-handed surgeons. We report the case of a 24-year-old female affected by KS, presenting with a history of symptomatic cholelithiasis. Ultrasound and magnetic resonance cholangiopancreatography confirmed SVI totalis and cholelithiasis. The patient underwent a laparoscopic cholecystectomy by a right-handed surgeon performed with a mixed approach without complications. Laparoscopic cholecystectomy in SVI patients can be a safe and reliable technique especially for a left-handed surgeon. The described technique is also easy for a right-handed surgeon. However, it is considered a technically challenging procedure and often requires technical modification.

Laparoscopic Cholecystectomy in a Patient with Inversion of the Abdominal Cavity

Situs viscerum inversus totalis is a rare condition in which organs are transposed from the normal side to the opposite side in the abdominal and chest cavity. It occurs in a ratio from 1:5000 to 1:20000. In this case report, a case of a 50-year-old man who was diagnosed with the symptomatic presence of gallstones with the usage of ultrasound. The patient underwent the laparoscopic cholecystectomy, the surgical procedure lasted for 90 minutes, it was successfully completed and the patient was discharged on the first postoperative day.

Kartagener syndrome – a very rare cause of neonatal respiratory distress

We report on a newborn with respiratory distress and situs viscerum inversus totalis. Kartagener syndrome was suspected because of respiratory distress, oxygen dependence, atelectasis, thick nasal mucus, productive cough and situs viscerum totalis. The diagnosis of primary ciliary dyskinesia was confi rmed by electron microscopy. We suggest that, despite its rarity, primary ciliary dyskinesia should be considered in any newborn with unexplained respiratory distress. Also, we emphasize the diagnostic role of thick nasal mucus and productive cough, both very rarely seen in neonates. Early diagnosis of primary ciliary dyskinesia may allow for early initiation of physiotherapy and multidisciplinary care, in order to preserve lung function in this genetic disease as long as possible. To our knowledge, this is the fi rst report of Kartagener syndrome diagnosed in a newborn in Croatia.

Percutaneous closure of patent foramen ovale in a patient with situs viscerum inversus

We describe the case of a patient with situs viscerum inversus totalis in whom we performed percutaneous closure of a patent foramen ovale. This case report may represent a further contribution to illustrate instrumental and interventional issues to consider in patients with situs viscerum inversus; it is also an example in which a background in embryology and congenital heart disease may aid cardiologists for the well-tolerated and effective diagnosis and treatment of adult patients with cardiac anomalies.

Laparoscopic cholecystectomy for acute cholecystitis in pregnancy: a case report in woman with situs viscerum inversus

We report a case of a three month young pregnant woman (In Vitro Fertilization and Embryo Transfer - IVF-ET - twin pregnancy) with situs viscerum inversus totalis affected by acute cholecystitis. As already happened in other pregnant women, we use laparoscopic approach and cholecystectomy is performed successfully without any morbidity for mother and fetuses.

Elective laparoscopic cholecystectomy in a 75-year-old woman with situs viscerum inversus totalis.

Situs viscerum inversus totalis is a rare disorder presenting with complete transposition of thoracic and abdominal viscera. It is associated with certain organ anomalies, but it is not a predisposing factor to cholecystolithiasis. To date, fewer than 100 cholecystectomies in patients with situs inversus have been published worldwide. We report a case of a 75-year-old woman referred to our hospital with abdominal pain in the left hypochondrium. Situs inversus totalis and acute calculous cholecystitis were diagnosed and successfully conservatively treated with antibiotics. The patient underwent elective laparoscopic cholecystectomy 3 months later. The procedure and postoperative course were uneventful and the patient recovered well. The clinical presentation of these patients with cholecystolithiasis may be confusing and vague and the correct diagnosis delayed. Laparoscopic cholecystectomy is the gold standard in the treatment even though the operation requires some modifications in operating theatre arrangement and position of the surgical team. Most surgeons are right-handed, and to operate laparoscopically in the “mirror image” anatomical situation using mainly the left hand for dissection may be stressful, uncomfortable and more time-consuming. Some recommendations to overcome this issue have been published. In conclusion, the above-mentioned anomaly may cause some risk and delay of the exact diagnosis, but it is not dangerous in itself. Laparoscopic cholecystectomy is a safe procedure, even in the case of acute cholecystitis, if performed by an experienced laparoscopic surgeon. The most dangerous is always an incautious and too self-confident surgeon.

'Zero' fluoroscopic exposure for ventricular tachycardia ablation in a patient with situs viscerum inversus totalis

Situs viscerum inversus totalis (SVIT) is a congenital disorder characterized by mirror reversal of the thoracic and abdominal organs. Different studies have shown that the ablation procedure can be performed without fluoroscopy with safety and effectiveness, in the setting of supraventricular tachycardia. We successfully performed an anatomical map and a radiofrequency catheter ablation of ventricular arrhythmia in a patient with SVIT without fluoroscopy.

LVAD in situs viscerum inversus totalis

Implantation of wearable left ventricular assist devices (LVADs) may be challenging in the presence of complex congenital morphology. Indeed, isolated dextrocardia,1,2 and complex malformations, including transposition and single-ventricle lesions,3 may eventually lead to irreversible ventricular failure, requiring long-term mechanical life support. Herein we present a case of implantation of a totally intrathoracic LVAD (HeartMate II; Thoratec Corporation, Pleasanton, CA) as bridge to transplantation in a 58-year-old patient with ischemic cardiomyopathy in situs viscerum inversus totalis.

Successful pacemaker implantation in a patient with dextrocardia situs inversus totalis

A 46-year-old woman presented to our department with the complaint of palpitation and dizziness for 2 months. Five years ago, she had undergone atrial septal defect repair by surgery. Diagnosis of dextrocardia associated with situs viscerum inversus totalis (dextrocardia, right gastric bubble, and left liver) was made using X-ray fluoroscopy and B-type ultrasound. Echocardiography demonstrated mirror image dextrocardia, enlarged right and …

Recurrent respiratory infections with severely damaged lung functions: Kartagener's syndrome: Case report

Kartagener's (or Siewert) syndrome represents a clinical presentation of primary ciliary diskinesia (PCD) with 3 dominant symptoms: bronchiectasiae, chronic sinusitis and situs viscerum inversus totalis or dextrocardia, only. Siewet demonstrated the first case of this clinical phenomenon in 1904, which was recognized by Kartagener in 1933, as a congenital disorder. PCD is an autosomal recessive disease with extensive genetic heterogenity. Dyskinetic or completely absent motiliy of cilia predisposes to recurrent pulmonary and upper respiratory tract infections resulting in bronchiestasis. Also, infections of the middle ear are common due to lack of ciliary movement in the Eustachian tube. Men have reduced fertility due to spermatozoa with absent motility or abnormalities in the ductuli efferentes. Our case report represents a middle age woman, treated ambulatory for many years as a chronic obstructive pulmonary disease (COPD). The patient noted recurrent upper respiratory tract infections from her childhood, headaches and recurrent sinusitis. Also, she had extrauterine pregnancy, no children, in spite of several arteficial inseminations. Due to the clinical signs of the right heart failure and the described ECG changes, the echocardiographic examination was done, which showed the dextracardia and the ultrasonographic examination of the abdomen revealed the situs inversus, the finding being within the physiological limits. All data regarding situs viscerum invesrus, supported by CT verification of bronchiectasiae and chronic inflammation of maxillar sinus led us to conclude that the patient suffered from Kartagener's syndrome.

Laparoscopic Cholecystectomy in Situs Viscerum Inversus Totalis

A 45-year-old female Saudi with a known diagnosis of situs viscerum inversus and chronic myeloid leukemia, for which she had completed her chemotherapy course, presented to the medical services with recurrent attack of left upper quadrant abdominal pain and vomiting, with no history of jaundice. All her hematological and biochemical profiles were reported to be normal. Her radiological investigations confirmed situs viscerum inversus totalis with thick-walled gallbladder, containing multiple stones and normal caliber common bile duct (CBD). After clearly defining the anatomy of the biliary tract by operative cholangiogram and careful dissection, cholecystectomy was carried out as a mirror image of the usual laparoscopic cholecystectomy done for the right side of the gallbladder (Figure 1). Intraoperative cholangiogram showed filling defects in the distal part of CBD (Figure 2). An endoscopic retrograde cholangiopancreatography (ERCP) performed in the immediate postoperative period showed no stones, but histopathology confirmed the diagnosis of chronic cholecystitis.

Un caso di destrocardia con Situs Viscerum Inversus Totalis concordante in coppia di gemelle DZ

SUMMARYThe authors describe a case of « situs viscerum inversus totalis » in two DZ twin-sisters.They debate, on the basis of the elements in their possession, whether they have to do with DZ or MZ twin-sisters, and declare in favour of the former hypothesis. Accordingly, this is the fifth case described of such anomaly in twins, after the cases of Reinhardt, Pezzi and Carugati, Boccia and Maglione, Kean, and it is the first case in DZ twins.The authors think the case described will contribute in winning for DZ twinship an acknowledgement of real twinship, according to Gedda's statements.