A Rare Anatomical Variation Complicating A Diffuse Abdominal Pain Presentation: Colonic Perforation in Situs inversus totalis

Situs inversus totalis is an inherited condition characterized by a mirror-image transposition of thoracic and abdominal organs. It often coexists with other anatomical variations. Transposition of the organs imposes special demands on the diagnostic and surgical skills of the surgeon. We report a case of a 34-year-old female patient presented with left upper quadrant pain, signs of acute abdomen, and unknown situs inversus totalis. Severe acute cholecystitis was diagnosed, and an uneventful laparoscopic cholecystectomy was performed. A posterior cystic artery was identified and ligated. Laparoscopic cholecystectomy is feasible in patients with severe acute calculus cholecystitis and situs inversus totalis; however, the surgeon should be alert of possible anatomic variations.

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Living donor hand-assisted laparoscopic nephrectomy in a healthy individual with situs inversus totalis: no need to turn down the donor

BMJ Case Reports ◽

10.1136/bcr-2019-233523 ◽

2020 ◽

Vol 13 (1) ◽

pp. e233523

Author(s):

Stan Benjamens ◽

Tamar Alice Johanne van den Berg ◽

Johan Frédéric Michel Lange ◽

Robert Alexander Pol

Keyword(s):

Situs Inversus ◽

Living Donor ◽

Sagittal Plane ◽

High Volume ◽

Situs Inversus Totalis ◽

Laparoscopic Nephrectomy ◽

Close Relative ◽

Living Kidney Donors ◽

Abdominal Organs ◽

Thoracic And Abdominal

A 70-year-old healthy male individual offered to undergo a living donor hand-assisted laparoscopic nephrectomy to enable kidney transplantation for a close relative. As required for all living transplant donor candidates, extensive screening was performed to exclude potential contraindications for donation. Tests revealed a situs inversus totalis, meaning a complete transposition of the thoracic and abdominal organs in the sagittal plane. As other contraindications for living kidney donation were absent, the feasibility of this procedure was determined multidisciplinary. A successful donation procedure was performed without surgical complications for the donor and good short-term transplant outcomes. In line with current developments that have resulted in more liberal criteria for potential living kidney donors, major anatomical deviations should not automatically be a contraindication. With multidisciplinary efforts and thorough surgical preparation at a high-volume transplant centre, this procedure is feasible and safe.

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Minimally invasive esophagectomy with intrathoracic anastomosis in a situs inversus totalis patient

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa480 ◽

2020 ◽

Vol 2020 (11) ◽

Author(s):

Yunchong Meng ◽

Han Xiao ◽

Zheng Zhang ◽

Kuo Li ◽

Quanfu Huang ◽

...

Keyword(s):

Esophageal Cancer ◽

Situs Inversus ◽

Minimally Invasive Esophagectomy ◽

Rare Condition ◽

Situs Inversus Totalis ◽

Intrathoracic Anastomosis ◽

Invasive Esophagectomy ◽

Abdominal Organs ◽

Congenital Condition ◽

Thoracic And Abdominal

Abstract Situs inversus totalis (SIT) is a rare congenital condition, which is characterized by abnormal placement of the thoracic and abdominal organs. The incidence of this condition is estimated to be from 1/8000 to 1/25,000. There have been minimal reports on SIT patients with esophageal cancer. In this report, we discuss a patient with SIT complicated by middle and lower esophageal cancer who underwent laparoscopic and thoracoscopic esophagectomy with intrathoracic anastomosis, and provide useful information with regards to treatment of this rare condition.

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Laparoscopic simple nephrectomy patient wıth situs inversus totalis and left renal hypoplasia: A case report

Canadian Urological Association Journal ◽

10.5489/cuaj.2824 ◽

2015 ◽

Vol 9 (7-8) ◽

pp. 521 ◽

Cited By ~ 1

Author(s):

Haci Ibrahim Cimen ◽

Yavuz Tarik Atik ◽

Oztug Adsan

Keyword(s):

Case Report ◽

Situs Inversus ◽

Situs Inversus Totalis ◽

Renal Hypoplasia ◽

Normal Side ◽

Laparoscopic Procedures ◽

Abdominal Organs ◽

Opposite Position ◽

Thoracic And Abdominal

Situs inversus totalis (SIT) is a relatively rare anatomical condition characterized by the transposition of thoracic and abdominal organs from the normal side to the opposite position. Most reports of laparoscopic procedures in patients with SIT cite technical difficulties and longer operative times due to disorientation because of the reversed abdominal organs and necessary modification of the surgeon’s movements and techniques. We present a case of a patient with SIT in whom a transperitoneal laparoscopic simple nephrectomy was performed.

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Double Rarity: Malignant Masquerade Biliary Stricture in a Situs Inversus Totalis Patient. A Case Report

10.21203/rs.3.rs-67136/v1 ◽

2020 ◽

Author(s):

Katalin Eitler ◽

Zoltan Mathe ◽

Veronika Papp ◽

Attila Zalatnai ◽

Andras Bibok ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Situs Inversus ◽

Anatomical Variation ◽

Significant Risk ◽

Magnetic Resonance Cholangiopancreatography ◽

Situs Inversus Totalis ◽

Recent Onset ◽

Benign Biliary Strictures ◽

Duct Stricture

Abstract Background. Situs inversus totalis is a rare anatomical variation of both the thoracic and the abdominal organs. Common bile duct strictures can be caused by malignant and benign diseases as well. 7-18% of the latter ones are 'malignant masquerade’ cases, as pre-operative differentiation is difficult. Case presentation. We present the case of a 68y male patient with known situs inversus totalis and a recent onset of obstructive jaundice caused by a malignant behaving common bile duct stricture. Technically difficult endoscopic retrograde cholangiopancreatography, brush cytology, magnetic resonance cholangiopancreatography, endoscopic ultrasound, and percutaneous transhepatic drainage with stent implantation were performed for proper diagnosis. Cholecystectomy, common bile duct resection with hilar lymphadenectomy and a hepatico-jejunostomy has been performed following multidisciplinary consultation. The final histology report did not confirm any clear malignancy, the patient is doing well.Conclusion. In situs inversus patients, both diagnostic and therapeutic procedures can lead to various difficulties. Benign biliary strictures are frequently misdiagnosed preoperatively as cholangiocellular carcinoma. The surgery is usually unavoidable, involving a significant risk of complications.The co-existence of these two difficult diagnostic and therapeutic features made our case challenging.

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An Incidental Finding of Situs Ambiguus with Polysplenia in an Asymptomatic 70-Year-Old Male

Journal of Clinical Case Studies Reviews & Reports ◽

10.47363/jccsr/2021(3)178 ◽

2021 ◽

pp. 1-3

Author(s):

Christopher Ambrogi ◽

◽

Madina Ndoye ◽

Keyword(s):

Prostate Cancer ◽

Urinary Retention ◽

Acute Urinary Retention ◽

Incidental Finding ◽

Anatomical Variation ◽

Rare Condition ◽

Situs Ambiguus ◽

Abdominal Organs ◽

The Right ◽

Thoracic And Abdominal

The term “Situs ambiguus” describes the configuration when some, but not all thoracic and abdominal organs are abnormally positioned. It is commonly associated with polysplenia, or multiple spleens. 50-100% of situs ambiguus with polysplenia have associated cardiac malformations [1]. We present a 70 year old male who came to our hospital for complete, acute, urinary retention, and was found to have invasive prostate cancer. Incidentally, the liver was positioned on the left side, and the spleen was located on the right side. There were multiple perisplenic nodular formations with peripheral calcifications that had enhancement kinetics similar to those of the spleen, suggesting polysplenia. In low thoracic cuts, the tip of the heart was clearly on the left side. The presence of situs ambiguus with polysplenia in the absence of cardiac abnormalities makes this case a unique presentation of an already rare condition. Clinicians should regularly consider the possibilities of anatomical variation in their medical and surgical practices.

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Incidental diagnosis of situs inversus totalis: a perspective from an emergency department attendance

BMJ Case Reports ◽

10.1136/bcr-2021-242337 ◽

2021 ◽

Vol 14 (4) ◽

pp. e242337

Author(s):

Umma-Kulthum Abdullahi Umar ◽

Aysha Najim Alremeithi ◽

Hasan Qayyum

Keyword(s):

Emergency Department ◽

Situs Inversus ◽

Anatomical Variation ◽

Vital Signs ◽

Situs Inversus Totalis ◽

Cardiac Complications ◽

X Rays ◽

Future Health ◽

Normal Limits ◽

Chest X Ray

A 30-year-old man of African origin presented to our emergency department (ED) with subjective fever and abdominal pain which started on the day of attendance. Vital signs and systemical examination were within normal limits. As part of his evaluation in ED, a 12-lead electrocardiogram was performed which showed features consistent with dextrocardia later confirmed on a chest X-ray as well. An ultrasound scan of the abdomen was performed which showed mirror imaging of the abdominal viscera, all of which were otherwise structurally normal. A diagnosis of situs inversus totalis was made. The patient’s symptoms resolved with analgesia and he was discharged with advice to follow-up in our hospital’s outpatient department. The diagnosis of situs inversus in the ED is a tricky one to make and most cases of this condition are discovered incidentally, as in our case. The mirror-imaged arrangement of viscera can have implications on the site of localised complaints, the physical examination, future health problems for the patient including anaesthesia risks, chronic lung conditions, cardiac complications and specialised trauma management. This anatomical variation can pose diagnostic challenges in such patients. Based on meticulous examination and readily accessible investigations including X-rays, 12-lead ECG and ultrasound, a timely diagnosis can be made.

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Situs Inversus Totalis in a Dog With a Chronic Diaphragmatic Hernia

Journal of the American Animal Hospital Association ◽

10.5326/0450245 ◽

2009 ◽

Vol 45 (5) ◽

pp. 245-248 ◽

Cited By ~ 3

Author(s):

Tige H. Witsberger ◽

David I. Dismukes ◽

Efrat Y. Kelmer

Keyword(s):

Case Report ◽

Diaphragmatic Hernia ◽

Situs Inversus ◽

Situs Inversus Totalis ◽

Mirror Image ◽

Doberman Pinscher ◽

Clinically Normal ◽

Normal Orientation ◽

Congenital Condition ◽

Thoracic And Abdominal

Situs inversus totalis is a rare, congenital condition that is characterized by the development of the thoracic and abdominal viscera in a mirror image to their normal orientation. This case report describes the condition in a 4-year-old, spayed female Doberman pinscher that was evaluated for dyspnea following sedation. Radiography confirmed a diaphragmatic hernia. Situs inversus was discovered during surgical correction. The diaphragmatic rent was repaired, and the dog was clinically normal at recheck 13 months after surgery.

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