A case of situs inversus totalis with hemosuccus pancreaticus due to intrapancreatic pseudocyst perforation of the common hepatic artery treated with a vascular stent graft.

Hemosuccus pancreaticus (HP) is characterized by gastrointestinal bleeding from the papilla of Vater via the pancreatic duct. In this report, we describe a case of HP due to arterial perforation in a pancreatic pseudocyst and discuss the computed tomography (CT) findings and efficacy of stent graft placement. A 64-year-old man with a history of heavy alcohol use, situs inversus totalis, and total gastrectomy was hospitalized with hematochezia. Enhanced CT revealed a pseudoaneurysm in the common hepatic artery (CHA) with mildly high density in the main pancreatic duct. Subsequent CT revealed an enlarged cystic lesion with inflow of contrast medium. Angiography confirmed blood flow from the CHA into the pancreatic pseudocyst, and the patient was diagnosed with HP due to intrapancreatic pseudocyst perforation of the CHA pseudoaneurysm. Coil packing into the pseudocyst failed to block the blood flow, and a covered stent graft was placed into the CHA. The patient had an uneventful clinical course. The identification of a pseudoaneurysm and a high-density area in the main pancreatic duct on enhanced CT and changes in the pancreatic cyst diameter may indicate the acute phase of HP, and stent grafting is an effective treatment for intracystic arterial perforation.

One anastomosis gastric bypass in a patient with situs inversus totalis and severe obesity.

INTRODUCTION: Obesity is a widespread health concern, and bariatric surgery has shown promise as an effective treatment for addressing this issue. The increasing global prevalence of obesity has led to a rise in the occurrence of obesity alongside rare conditions such as situs inversus totalis (SIT). One of the most effective bariatric surgeries, one-anastomosis gastric bypass (OAGB), has gained popularity in recent years. MATERIALS AND SURGICAL TECHNIQUE: We report a successful case of OAGB in a patient with a body mass index (BMI) of 51.48 kg/m2 and SIT. DISCUSSION: It is worth noting that in skilled hands, OAGB can be both effective and safe for patients with anatomical abnormalities like SIT.

Coronary angiography in dextrocardia with situs inversus and acute myocardial infarction: A case report and literature review.

We present the case of a 74-year-old man with dextrocardia and situs inversus who presented with non-ST-elevation acute myocardial infarction. The patient underwent successful coronary angiography without requiring percutaneous coronary intervention or coronary artery bypass grafting. We discuss the patient's clinical characteristics, electrocardiography findings, diagnosis, and treatment, and review the relevant literature.

Situs Inversus, a Choledochal Cyst and a Horseshoe Kidney: A Strange Coincidence of Congenital Conditions.

Situs inversus is a condition in which abdominal and thoracic organs are laterally transposed. The organs which are supposed to be on the right side of the abdomen are on the left and vice versa. It is a rare congenital condition; however, the exact incidence is difficult to determine as most of the cases go unnoticed until they undergo an imaging study.  We report a case of a 30-year-old female presenting with situs inversus in association with a choledochal cyst and a horseshoe kidney. She underwent imaging evaluation for non-specific abdominal pain. Her routine clinical examination revealed a soft abdomen without any tenderness. Routine laboratory tests were within normal limits. Since there was abdominal pain, ultrasonography of the whole abdomen was advised. It revealed the presence of abdominal organs on the opposite side as normally seen. The common bile duct was dilated, and lower poles of the kidneys were fused. The cardiac apex was found to be on the right. It was followed up with a computed tomography scan which confirmed situs inversus. The common bile duct was dilated without any obstructive pathology in the pancreatic head or periampullary region. Lower poles of the kidneys were found to be fused together in front of the retroperitoneal vessels through an isthmus. Based on these findings, a diagnosis of situs inversus in a case of a choledochal cyst and a horseshoe kidney was made. Situs inversus is a rare entity. Its association with choledochal cysts and horseshoe kidneys has never been reported in the literature to the best of our knowledge.

Uniportal left middle lobectomy in a patient with situs inversus totalis: a case report.

BACKGROUND: Situs inversus totalis (SIT), a rare recessive autosomal disease, involves the complete transposition of the thoracic and abdominal viscera in the left-right axis. Patients with SIT combined with lung cancer are extremely uncommon. CASE PRESENTATION: We present a case of a 57-year-old woman with SIT who underwent uniportal video-assisted thoracoscopic left middle lobectomy for adenocarcinoma of the lung. The procedure was performed safely with adequate anatomical identification and careful intraoperative manipulation based on the preoperative three-dimensional-computed tomography bronchography and angiography (3D-CTBA). The patient's perioperative period was uneventful, and no recurrence was observed 2 year postoperatively. CONCLUSION: With the preoperative planning of the 3D-CTBA, uniportal video-assisted thoracoscopic lobectomy in lung cancer patients with sit can be performed safely and effectively.

Primary yolk sac tumor of the endometrium combined with situs inversus totalis: a case report and literature review.

BACKGROUND: Yolk sac tumor (YST) is a highly malignant germ cell tumor, a majority of which originate from the gonads and are extremely rare from endometrium. CASE PRESENTATION: Here we present a case of a 42-year-old woman suffered from primary pure yolk sac tumor of the endometrium complicated with situs inversus totalis. The patient presented at our hospital with irregular vaginal bleeding. Imageological examination showed a space-occupying lesion in the cervix and the serum Alpha-fetoprotein (AFP) level was significantly high (more than 1210ng/ml). Then she underwent total hysterectomy, bilateral salpingo-oophorectomy and pelvic lymph node dissection. The subsequent postoperative pathological diagnosis was yolk sac tumor arising from the endometrium. Next, the patient was treated with 6 cycles of chemotherapy with Pingyangmycin, etoposide and cisplatin regimen and was alive without evidence of recurrence or distant metastases for 13 months. CONCLUSIONS: This rare disease needs to be differentiated from endometrial epithelial neoplasia and the significant increase in AFP is helpful for diagnosis. Combined with previous literature reports, comprehensive staging laparotomy or maximum cytoreductive surgery complemented by standard chemotherapy can usually achieve a good efficacy.

Computed tomographic features of segmental aplasia of the caudal vena cava, portocaval shunt and Situs ambiguous in two dogs.

A 3-year-old crossbreed dog (case 1) and a 3-month-old German Shorthaired Pointer (case 2) were presented for acute signs of encephalopathy. A portosystemic shunt (PSS) was suspected based on clinical context and laboratory exam results and was confirmed on computed tomography (CT) angiography in both cases. A left-sided azygos (case 1) and right-sided azygos (case 2) continuation of an interrupted caudal vena cava (CVC) and a situs ambiguous (SA) were also observed and considered as incidental findings. Both dogs underwent PSS surgical correction. Postsurgical follow-up imaging procedures suggested concomitant primary hypoplasia of the portal vein (PHPV) in both cases.

A case of amoebic liver abscess and emphysematous gallbladder in a 65-year-old male with situs inversus totalis.

INTRODUCTION AND IMPORTANCE: Situs inversus totalis, a rare congenital condition, is characterized by the mirror-image reversal of the abdominal and thoracic organs. Amoebic liver abscess and emphysematous gallbladder are severe gastrointestinal infections. The coexistence of these three conditions is extremely rare. CASE PRESENTATION: We present the case of a 65-year-old male who presented with abdominal pain, fever, and jaundice. Investigations revealed situs inversus totalis, amoebic liver abscess, and emphysematous gallbladder. The patient underwent successful treatment with antibiotics and open surgery drainage of the liver abscess, and subtotal cholecystectomy. CLINICAL DISCUSSION: The co-occurrence of situs inversus totalis, amoebic liver abscess, and emphysematous gallbladder poses a diagnostic challenge and requires thorough evaluation and appropriate management. CONCLUSION: Situs inversus totalis may coincide with other conditions like amebic abscess and emphysematous gallbladder, complicating diagnosis and treatment. Early diagnosis and prompt intervention are crucial to improve outcomes.

Totally three-dimensional endoscopic mitral valve replacement in a patient with situs inversus totalis.

Situs inversus totalis (SIT) with dextrocardia is a rare congenital anomaly that poses a surgical challenge. This case report presents the first known case of a totally 3D endoscopic mitral valve replacement (MVR), which was performed in a 75-year-old woman with SIT and severe functional mitral regurgitation. Despite the anatomical complexity, the procedure was successfully completed using a simplified three-port system and a 3D endoscope by requiring careful preoperative planning and intraoperative adaptation to the mirrored anatomy of SIT. This case report demonstrates the feasibility and potential benefits of totally endoscopic MVR in patients withSIT.

Paraduodenal hernia with situs inversus abdominalis: A case report.

INTRODUCTION & IMPORTANCE: Situs Inversus Abdominalis (SIA) & Paraduodenal Hernias (PDH) are extremely rare causes acute surgical emergencies among adults. We present a case of an adult patient with intestinal obstruction secondary to PDH through the fossa of Landzert with concurrent SIA. PRESENTATION OF CASE: A thirteen-year-old Southeast Asian female with situs inversus abdominalis due to Kartagener syndrome presented with bowel obstruction. The patient failed conservative management and required surgical intervention. A diagnostic laparoscopy was done followed by laparotomy. Intraoperatively, there was a paraduodenal mesentery defect at the duodenojejunal junction with internal herniation of the terminal ileum and caecum. Successful reduction of bowels and closure of the mesentery defect was done without any bowel resection. DISCUSSION: Only three cases of bowel obstruction secondary to SIA have been documented in literature. This is the fourth and the only case to have concurrent paraduodenal hernia. Surgical repair of PDH is mandatory to avoid the increased risk of incarceration or strangulation however pre-operative diagnosis of PDH resembles a diagnostic challenge especially among patients with intestinal anomalies. CONCLUSION: Intestinal malrotation is known to be the most common cause of intestinal obstruction in patients with intestinal anomalies. However, clinicians should maintain a high index of suspicion of intestinal herniation and adhesions as the cause of intestinal obstruction in such cases. Further imaging such as computed tomography (CT) scan and diagnostic laparoscopy may be beneficial provided patients have no overt signs of acute bowel ischaemia.

Gallstones in a Looking-Glass: A Case Report on the Successful Laparoscopic Management of Cholelithiasis in Situs Inversus Totalis.

Situs inversus is an uncommon congenital condition where the internal organs are arranged in a mirrored or reversed orientation within the body. In this unique anatomical variation, the placement of visceral organs is flipped, presenting a mirror-image configuration relative to their standard positions. While situs inversus itself does not predispose an individual to gallbladder disorders, the anatomical variation poses unique challenges for healthcare professionals in managing abdominal pathologies. This case report describes the successful management of a 52-year-old male patient with situs inversus totalis who presented with gallstone-induced obstructive jaundice and underwent endoscopic retrograde cholangiopancreatography (ERCP) with stenting, followed by a laparoscopic cholecystectomy. The surgical procedure required exceptional visual-motor skills and extensive reorientation to accurately identify and navigate the left upper quadrant anatomy, which is the mirror image of the typical surgical approach. The case highlights the importance of thorough preoperative planning, comprehensive anatomical knowledge, and a multidisciplinary team approach to ensure favorable outcomes for patients with this rare condition.

Polysplenia with situs inversus totalis, azygos continuation of the inferior vena cava, and duplication of the superior vena cava in a healthy adult: A case report.

Polysplenia syndrome is an embryological disorder whereby the usual left-right asymmetry of thoracic and abdominal viscera fails to develop. It is a rare entity, estimated to occur at a frequency of 1 in 40,000, and is often associated with cardiac and biliary abnormalities. More than 75% of patients die before the age of 5 years, and even in the absence of cardiac anomalies, only 5%-10% of patients are expected to survive into adulthood without complications. Although polysplenia syndrome encompasses a wide range of anatomic abnormalities, there is no single pathognomonic feature. Hence, the prognosis of patients with polysplenia depends on their anatomy, thus necessitating radiology in their management. Here we present a case of a 56-year-old man with polysplenia syndrome and situs inversus totalis. This presentation is atypical because polysplenia is usually considered a form of situs ambiguus, and cases with situs inversus totalis are exceedingly rare. Also noted in our patient are variations in the great vessels, including aortic arch branches and the venae cavae which are features not typically associated with either polysplenia syndrome or situs inversus totalis. The patient is healthy and asymptomatic at baseline, with his diagnosis being made incidentally. Our case report is the first to describe this unique combination of cardiothoracic and cardiovascular anatomy. It also emphasizes the importance of radiologists in caring for patients with laterality defects. As these disorders are uncommon, more data on their anatomic variations may help provide better medical care to this patient population.

Orthotopic heart transplantation in patient with situs inversus and pectus excavatum: a case report.

BACKGROUND: Heart transplantation in patients with situs inversus is challenging, especially in terms of reconstruction of the systemic venous return. Several rerouting techniques have been presented but are associated with vulnerability to external compression, which might cause hemodynamic instability, especially in the presence of chest deformity. In this study, we report a rare case of successful heart transplantation in the presence of situs inversus and pectus excavatum. CASE PRESENTATION: A 55-year-old man, with a history of surgeries for corrected transposition of the great arteries with ventricular septal defect, was registered for heart transplantation owing to progression of heart failure. Subsequently, he had undergone a left ventricular assist device implantation; 14 years after registration, he underwent transplantation of the heart with normal anatomy. The inferior vena cava was reconstructed by anastomosing the left atria with a counterclockwise rotation of the donor heart and by lengthening the recipient inferior vena cava with a conduit made of the residual right atrial tissue. The superior vena cava was reconstructed using a donor innominate vein harvested with sufficient length. After successful weaning from cardiopulmonary bypass, the chest could not be closed because the heart was compressed owing to chest deformity, resulting in hemodynamic instability. Therefore, to exclude the left lung, a left pericardial screen was created using a bovine pericardium, allowing the chest to be closed with acceptable hemodynamics. The patient suffered postoperatively from a higher venous pressure, suggesting an obstruction of venous return early after surgery. The obstruction gradually resolved, and the patient was transferred for rehabilitation. CONCLUSIONS: Heart transplantation in the presence of situs inversus is challenging; moreover, the presence of pectus excavatum further complicates the procedure. The paradoxically larger left lung and chest deformity compressed and impaired reconstructed systemic venous return. Although intrathoracic exclusion of the left lung was effective, an intraoperative or early postoperative thoracoplasty for pectus excavatum was also a viable option. Patient-specific management is mandatory, depending on the anatomy.

Liver and pancreas transplantation in adult donor and recipients with situs inversus totalis: a case series and review of the literature.

BACKGROUND: Situs inversus totalis is a rare congenital anomaly characterized by a mirror-image orientation of abdominal, and in some cases, thoracic organs. Here, we report our situs inversus totalis transplantation experience and further review liver transplantations in adult recipients and donors with situs inversus totalis. CASE PRESENTATION: We describe three cases with situs inversus totalis. The first case was liver transplantation in a recipient (a 61-year-old Iranian man) with situs inversus totalis, the second was a liver transplantation from a donor (a 52-year-old Iranian woman) with situs inversus totalis, and finally, for the first time, a simultaneous pancreas and kidney transplantation in a recipient (a 26-year-old Iranian man) with situs inversus totalis. In patient one, hepatectomy could be performed according to the standard method and on the basis of preoperative studies. Hepatic vein and arterial anastomosis were performed as in every other patient without situs inversus totalis. To prevent biliary complications, a Roux-en-Y hepaticojejunostomy was performed. In patient two, implantation time, suprahepatic vein, portal vein, arterial, and biliary reconstruction could be done as in any other case without situs inversus totalis. Plication of the right-sided diaphragm and fixation of the falciform ligament was done for our patient. In patient three, systemic drainage was preferred to portal flow for establishing the outflow drainage of the pancreas compared with otherwise normal patients. CONCLUSION: Although situs inversus totalis is a rare condition, our reported techniques are suitable, considering advantages such as easier accessibility, more acceptable placement of the implanted organs regarding vascular variations, and the appropriate location of the allograft in the proximity of other organs.

[Right-sided acute appendicitis in situs inversus totalis. Case report]. / Apendicitis aguda del lado derecho en situs inversus totalis. Reporte de caso.

Background: Acute appendicitis is widely recognized as the prevailing abdominal surgical emergency globally, exhibiting an annual incidence ranging from 96.5 to 100 cases per 100,000 adults. Conversely, situs inversus totalis is a rare anatomical anomaly characterized by the complete reversal of the chest and abdominal organs, occurring in approximately 1 out of every 10,000 to 50,000 individuals. Clinical case: 53-year-old female patient who presented to the emergency department with a complaint of diffuse abdominal pain of colic nature that had persisted for 5 days. The patient referred systemic hypertension, pre-diabetes mellitus type 2, and situs inversus as relevant medical history. A laparotomy procedure was conducted, revealing a perforated appendix located in the right hypochondrium. Additionally, the patient exhibited situs inversus totalis, with the colon positioned in its normal anatomical location. Conclusions: Due to the low incidence of situs inversus totalis, in cases similar to the one presented, the utilization of image studies and laboratory studies is imperative for accurate diagnosis. In the face of diagnostic suspicions and inconclusive paraclinical studies, the most effective approach is to pursue surgical examination and intervention, preferably utilizing laparoscopic techniques.

Introducción: la apendicitis aguda es la urgencia quirúrgica abdominal más frecuente en el mundo, con una incidencia anual de 96.5 a 100 casos por 100,000 adultos. Por otra parte, el situs inversus totalis es un trastorno posicional inverso de los órganos torácicos y abdominales con una incidencia de 1 en 10,000 a 50,000 personas. Caso clínico: paciente del sexo femenino de 53 años que se presentó en sala de urgencias refiriendo dolor abdominal difuso tipo cólico de 5 días de evolución. La paciente refirió hipertensión arterial sistémica esencial, prediabetes mellitus tipo 2 y situs inversus. Se realizó intervención quirúrgica (laparotomía) en la que se encontró el apéndice perforado en hipocondrio derecho y situs inversus totalis con colon en posición anatómica normal. Conclusiones: debido a la baja incidencia del situs inversus totalis, el diagnóstico en casos como el presentado representa un reto en el que el uso de estudios de imagen y laboratorio resulta indispensable. Ante la sospecha diagnóstica y estudios paraclínicos con resultados no concluyentes, la mejor estrategia consiste en la exploración y el manejo quirúrgicos, preferentemente laparoscópicos.

Left-sided perforated appendicitis in a patient with situs inversus totalis, a case report.

Situs inversus, an uncommon disorder, causes the orientation of asymmetric organs to be opposite to that of normal anatomy. It can be either partial, affecting only the thoracic or abdominal cavities, or full, involving the transposition of both the thoracic and abdominal organs. A 31-year-old Ethiopian male patient presented with migratory abdominal pain in the left lower quadrant for 3 days. Associated with the pain, he experienced symptoms of nausea, vomiting of ingested matter, and loss of appetite. Investigations were consistent with left-sided appendicitis with situs inversus totalis. Therefore, the patient was operated on and discharged with no perioperative complications. Appendicitis is a rare cause of left lower quadrant pain. In order to reduce the delay in patient treatment and avoidable perioperative complications, emergency physicians, radiologists, and surgeons must become more knowledgeable about situs inversus and left side appendicitis.

Anesthetic management of a patient with congenital cyanotic heart anomaly for emergency surgery: A case report.

Among congenital cyanotic heart diseases (CHDs), situs inversus totalis with transposition of great vessels with a large ventricular septal defect (VSD) has a very low incidence of around 1 in 10,000. Hereby, we present a 16-year-old man with the aforementioned cardiac anomaly with cardiac arrhythmias, septic shock, and a history of road traffic accident-causing osteomyelitis of the left thigh requiring incision and drainage. The patient was admitted to the intensive care unit with a high-grade fever, narrow pulse pressure, and atrial fibrillation. The patient was operated on under general anesthesia with endotracheal intubation after optimization. Invasive monitoring, antiarrhythmics, and vasopressors were required intraoperatively, and surgery progressed uneventfully. Furthermore, the patient had undergone a series of debridements after 8 days, which were performed under regional anesthesia uneventfully. This case report represents a plan of action for perioperative anesthetic management and anticipates the difficulties for CHD patients in the course of surgery and subsequential prudence.

Aphasia due to right hemisphere infarction in a patient with situs inversus after carotid artery stenting: a case report.

BACKGROUND: Situs inversus (SI) is a rare congenital anomaly in which systemic organs and vessels are positioned in a mirror image of their normal positions. An interesting issue regarding individuals with such a condition is whether they also have reversed brain asymmetries. Most of studies on this issue indicate that, similarly to many people with normal visceral alignment, patients with SI have a left hemispheric dominance for language functions. CASE PRESENTATION: We report a rare occurrence of anomalous cerebral dominance for language in a patient with complete situs inversus. The right-handed patient developed aphasia after carotid stenting, and brain magnetic resonance imaging showed cerebral infarction in the right parietal lobe. CONCLUSION: Anomalous cerebral dominance for language and visceral situs inversus in our patient both may result from a single, genetically coded atypicality of developmental gradient.

Anaesthetic implications in situs inversus totalis: A case report.

Situs inversus totalis (SIT) is a rare congenital condition which is characterised by the reversal of orientation of abdominal and thoracic organs where heart is on the right side of the thoracic cavity and liver on the left side, whereas stomach and spleen are on the right side in the abdomen. The reported prevalence of this anomaly is one in 5,000- 20,000 live births. This case reports the anaesthetic management of situs inversus totalis in a 38-year-old male patient, with a history of poorly differentiated adenocarcinoma of the colon, who underwent laparoscopic intervention converted to open nodular excision with incisional hernia repair. The report analyses the anaesthetic implications and challenges associated with situs inversus totalis during surgery, including preoperative evaluation, monitoring techniques and potential complications.

Association between situs inversus and maternal SARS-CoV-2 infection at gestational age 4-6 weeks.

BACKGROUND: A dramatic increase in fetal situs inversus diagnoses by ultrasound in the months following the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) surge of December 2022 in China led us to investigate whether maternal SARS-CoV-2 exposure could be associated with elevated risk of fetal situs inversus. METHODS: In this multi-institutional, hospital-based, matched case-control study, we investigated pregnant women who underwent ultrasonographic fetal biometric assessment at gestational weeks 20-24 at our hospitals. Each pregnant woman carrying a situs inversus fetus was randomly matched with four controls based on the date of confinement. Relevant information, including SARS-CoV-2 infection, and other potential risk factors were collected. Conditional logistic regression was used to test possible associations between fetal situs inversus and SARS-CoV-2 infection at different gestational weeks as well as individual risk factors. FINDINGS: A total of 52 pregnant women diagnosed with fetal situs inversus between January 1 and October 31, 2023 and 208 matched controls with normal fetuses were enrolled. We found no association between an increased risk of fetal situs inversus with gestational SARS-CoV-2 infection or with other risk factors. However, fetal situs inversus was significantly associated with SARS-CoV-2 infection specifically in gestational weeks 4-6 (adjusted odds ratio [aOR] 6.54 [95% confidence interval 1.76-24.34]), but not with infection at other gestational ages, after adjusting for covariates. CONCLUSIONS: Increased risk of fetal situs inversus is significantly associated with maternal SARS-CoV-2 infection at gestational weeks 4-6, corresponding to the fetal developmental window for visceral lateralization in humans. FUNDING: National Key R&D Program of China, etc.