Situs Inversus Totalis (SIT) with Hepatocellular Carcinoma (HCC): A Rare Case Report and Review of 12 Other Cases.

Hepatocellular carcinoma (HCC) is the seventh-most common malignancy in males and ninth in females with incidence of one million new cases every year. Situs inversus totalis (SIT) is a rare congenital condition, in which there is a mirror-image transposition of both the abdominal and thoracic viscera. There are very few reported cases of HCC developing in people with SIT. In this review, we present a new case of HCC with SIT, and a review of literatures published between 1983 and 2011 on it. The literatures in English were searched through PubMed and Google Scholar, while those in Japanese language were accessed through J-EAST and translated in English with the help of Google translator on 22 April 2012. There are 6 English and 6 Japanese literatures showing 12 published cases, of which 10 cases were from Japan, 1 from Taiwan and 1 from China. Our case is probably the first case in the world beyond these regions. The articles containing adequate information, such as patient age and sex, investigations, diagnosis, type of congenital anomalies and methods of surgery, were reviewed. On reviewing the literature, we observed that clinical manifestations, laboratory findings and etiology correlate well with HCC, while anomalous hepatic vascularity correlates well with SIT. The reason for high incidence of HCC with SIT in Japan is not well correlated, but may be explained by higher incidence of SIT. All varieties of hepatic resection were feasible in cases of SIT.

Laparoscopic appendicectomy in a patient with situs inversus totalis.

Situs inversus totalis (SIT) is a rare condition with a genetic predisposition, wherein organs or organ systems are transposed from their normal sites to locations on the opposite side of the body (the mirror image of normal). The syndrome may include transposition of the thoracic viscera, the abdominal viscera, or more commonly, both. The incidence has been calculated variously as 1 in 6,000-35,000 live births. We present the case of a 22-year-old man with SIT with acute appendicitis. Patient was treated with laparoscopic appendicectomy which is invaluable in both diagnosis and treatment of such patients.

Acute small bowel obstruction due to intussusception of malignant amelonatic melanoma of the small intestine.

Malignant melanoma is a common malignancy and cutaneous melanoma showed an unusual prediction to metastasise into the small intestine. At autopsy metastatic deposits found in 50-60%, but less than 2-4% of melanoma patients diagnosed to have gastrointestinal (GI) metastasis during the disease course and 4-9% GI melanoma had unknown primary melanoma, which should be considered metastatic because primary lesion may be very small to diagnose or had regressed spontaneously. Few cases reported to have intussusception as a presenting feature. We report a case of amelanotic metastatic melanoma presented with intussusception and without known primary melanoma. The patient presented with abdominal pain, vomiting and distension. He was diagnosed as having acute intestinal obstruction as confirmed by erect abdominal x-ray. Ultrasonography showed small intestine intussusception. Emergency laparotomy revealed ilieo-ileal-type intussusception with intraluminal mass, which was resected and end-to-end anastomosis of bowel was performed. Histopathological and immunohistochemical examination of the resected specimen showed amelanotic melanoma.