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1.
Medicine (Baltimore) ; 99(31): e21439, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756156

RESUMO

RATIONALE: Duodenal atresia in association with situs inversus abdominus is extremely rare. Care should be taken when selecting appropriate surgical methods, and caution should be exercised during the surgery to avoid misdiagnosis and mistreatment. With prompt recognition of the condition, the surgical procedure should be performed in a timely manner to achieve positive results. PATIENT CONCERNS: A newborn affected by situs inversus abdominus associated with duodenal atresia, midgut malrotation, and volvulus. DIAGNOSIS: Congenital duodenal atresia with situs inversus abdominis. INTERVENTIONS: Diamond-shaped duodenoduodenostomy with appendectomy was performed, with the release of Ladd band and correction of the malrotation. OUTCOMES: The baby boy is thriving well with no abdominal complaints at 4 years of surgical follow-up. LESSONS: Although several theories are put forward to clarify this matter, the proper cause of duodenal atresia is not well defined. Clinical symptoms and examinations can assist diagnosis, the definitive cause should be ascertained by surgical approach. And the operating surgeon must be aware of the "mirror anatomy" to prevent unnecessary injuries. Additionally, long-term prognosis for duodenal atresia are very good, therefore, careful attention in postoperative management are important in such a case.


Assuntos
Obstrução Duodenal/congênito , Obstrução Duodenal/complicações , Obstrução Duodenal/cirurgia , Duodeno/cirurgia , Atresia Intestinal/complicações , Atresia Intestinal/cirurgia , Situs Inversus/complicações , Assistência ao Convalescente , Anastomose Cirúrgica/métodos , Apendicectomia/métodos , Anormalidades do Sistema Digestório/complicações , Anormalidades do Sistema Digestório/diagnóstico , Obstrução Duodenal/diagnóstico , Humanos , Recém-Nascido , Atresia Intestinal/diagnóstico , Volvo Intestinal/complicações , Volvo Intestinal/diagnóstico , Masculino , Situs Inversus/diagnóstico , Resultado do Tratamento
2.
Cardiol Young ; 29(10): 1310-1312, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31475660

RESUMO

Femoral vein access is the first choice for percutaneous atrial septal defect closure, and when it cannot be used due to anatomic reasons, the alternative sites should be considered, frequently increasing the complexity of the procedure. Here we report the case of a 3-year-old boy, with situs inversus and dextrocardia, electively referred for percutaneous closure of an ostium secundum atrial septal defect. During the procedure, agenesis of the infra-hepatic segment of the inferior caval vein was diagnosed, and no double inferior caval vein or right superior caval vein were identified by ultrasound or angiography. Therefore, we opted to perform the procedure through the left internal jugular vein, with fluoroscopy and transesophageal echocardiographic guidance. Catheters were navigated through a hydrophilic guidewire, and a Stiff guidewire was positioned in the left ventricle for better support. An Amplatzer septa occluder 19 was successfully deployed without major difficulties and the patient was discharged after 24 hours in good clinical condition. Percutaneous atrial septal defect closure through alternative access sites, especially in the presence of situs inversus, may pose significant challenges to the interventional team. In this case, the left internal jugular vein has shown to be a feasible option, allowing the navigation and manipulation of devices without complications. Provided the expertise of the interventional team, and awareness of the risks involved, alternative access sites can be successfully used for paediatric structural interventions.


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Comunicação Interatrial/cirurgia , Dispositivo para Oclusão Septal , Situs Inversus/diagnóstico , Cirurgia Assistida por Computador/métodos , Veia Cava Inferior/anormalidades , Pré-Escolar , Ecocardiografia Transesofagiana , Fluoroscopia , Comunicação Interatrial/diagnóstico , Humanos , Veias Jugulares , Masculino
3.
Neonatal Netw ; 38(2): 98-106, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31470372

RESUMO

BACKGROUND: VACTERL association is a sporadic, nonrandom series of congenital malformations diagnosed by the presence of three or more of the following: vertebral malformations, anal atresia, cardiac defects, tracheoesophageal fistula, renal malformations, and limb malformations. Situs inversus totalis (SIT) and esophageal malformations are rarely associated. This is the first reported case in North America of VACTERL association with SIT. IMPLICATIONS FOR PRACTICE: Respiratory distress in the term infant requires full exploration of all possible causes because the etiology may be far more complex than routinely diagnosed respiratory distress syndrome. This particular case demonstrates physical exam findings and supportive imaging that would be observed in infants with VACTERL association and with SIT, highlighting considerations when, rarely, both occur simultaneously.


Assuntos
Canal Anal/anormalidades , Esôfago/anormalidades , Cardiopatias Congênitas , Rim/anormalidades , Deformidades Congênitas dos Membros , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Situs Inversus , Coluna Vertebral/anormalidades , Traqueia/anormalidades , Assistência ao Convalescente/métodos , Canal Anal/fisiopatologia , Diagnóstico Diferencial , Esôfago/fisiopatologia , Feminino , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/fisiopatologia , Cardiopatias Congênitas/terapia , Humanos , Recém-Nascido , Rim/fisiopatologia , Deformidades Congênitas dos Membros/complicações , Deformidades Congênitas dos Membros/diagnóstico , Deformidades Congênitas dos Membros/fisiopatologia , Deformidades Congênitas dos Membros/terapia , Triagem Neonatal/métodos , Administração dos Cuidados ao Paciente/métodos , Exame Físico/métodos , Radiografia Abdominal/métodos , Radiografia Torácica/métodos , Situs Inversus/complicações , Situs Inversus/diagnóstico , Situs Inversus/fisiopatologia , Situs Inversus/terapia , Coluna Vertebral/fisiopatologia , Traqueia/fisiopatologia , Doenças do Nervo Vestibulococlear/congênito , Doenças do Nervo Vestibulococlear/diagnóstico
4.
Pan Afr Med J ; 32: 167, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31303936

RESUMO

Retro-costo-xyphoidian hernia is a rare congenital malformation. It accounts for 3% of all the diaphragmatic hernias. It can be isolated or associated with other malformations. We here report a very rare case of Morgagni-Larrey hernia and situs inversus totalis detected after neonatal respiratory distress.


Assuntos
Hérnias Diafragmáticas Congênitas/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Situs Inversus/diagnóstico , Hérnias Diafragmáticas Congênitas/complicações , Humanos , Recém-Nascido , Masculino , Situs Inversus/complicações
5.
J Card Surg ; 34(9): 863-866, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31233237

RESUMO

Reoperations in cardiac surgery are very difficult and risky operations due to possible complications. A 35-week pregnant, 27-year-old woman patient presented to the cardiology department with palpitations. Control transthoracic echocardiography revealed a mass in the right atrium with dimensions of 24 × 25 mm. The patient had dextrocardia and situs inversus totalis, and had undergone a robotic atrial septal defect repair operation 1 year ago. Operation was planned for the patient with the joint decision of cardiology, obstetrics, pediatrics, anesthesia, and cardiovascular surgery departments. Redo robotic heart surgery was performed in beating heart after the operation of the cesarean, and the mass in the right atrium was successfully removed. In conclusion, as it is seen in our case, robotic cardiac surgery can be safely and successfully performed, and can minimize morbidity and mortality even in very complex clinical conditions such as pregnancy, dextrocardia, and reoperation.


Assuntos
Anormalidades Múltiplas , Procedimentos Cirúrgicos Cardíacos/métodos , Cesárea/métodos , Dextrocardia/cirurgia , Complicações Cardiovasculares na Gravidez , Procedimentos Cirúrgicos Robóticos/métodos , Situs Inversus/cirurgia , Adulto , Aberrações Cromossômicas , Dextrocardia/diagnóstico , Ecocardiografia , Feminino , Humanos , Recém-Nascido , Gravidez , Situs Inversus/diagnóstico , Tomografia Computadorizada por Raios X
6.
Surg Laparosc Endosc Percutan Tech ; 29(3): e29-e33, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30889057

RESUMO

BACKGROUND: Situs inversus (SI) is a rare congenital anomaly characterized by the transposition of thoracic and abdominal viscera. Laparoscopic pancreaticoduodenectomy (LPD) is increasingly used in patients with periampullar and pancreatic carcinomas. For patients with SI, LPD can be more complicated because of reversed anatomy and possible other associated anomalies that have not been expected before surgery. CASE PRESENTATION: A female patient with SI totalis presented with inappetence, vomiting, and weight loss for 2 months. Imaging modalities and angiography revealed a mass in the periampullary region without obvious vascular abnormalities. The mass was successfully resected via LPD based on an elaborate preoperative plan. The surgical pathology report demonstrated adenocarcinoma of the duodenal papilla. The patient has been followed up for 4 months and no tumor recurrence or long-term complications were observed. CONCLUSION: LPD is technically difficult but feasible in patients with SI.


Assuntos
Adenocarcinoma/cirurgia , Ampola Hepatopancreática/cirurgia , Neoplasias Duodenais/cirurgia , Laparoscopia/métodos , Pancreaticoduodenectomia/métodos , Situs Inversus/complicações , Adenocarcinoma/complicações , Colestase/diagnóstico , Colestase/cirurgia , Neoplasias Duodenais/complicações , Estudos de Viabilidade , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Imagem Multimodal , Situs Inversus/diagnóstico , Tomografia Computadorizada por Raios X , Ultrassonografia
7.
Am J Case Rep ; 20: 78-82, 2019 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-30659166

RESUMO

BACKGROUND Left-sided acute appendicitis, although well described in the literature, is still an easily missed diagnosis. Midgut malrotation and situs inversus are 2 known leading conditions that contribute to misdiagnosis of appendicitis. CASE REPORT Here is the case of a 27-year-old male without any previous medical history, who presented with left lower quadrant tenderness and was misdiagnosed with gastroenteritis as an outpatient and sent home; the patient presented the next day to the emergency department where he was found to have acute appendicitis with situs inversus. He underwent laparoscopic appendectomy where a phlegmon was identified. Pathology came back as peri-appendiceal mucocele with no signs of malignancy. CONCLUSIONS This case report aimed to revisit the idea of left-sided acute appendicitis and discuss the management of a perforated appendiceal mucocele contained by a phlegmon.


Assuntos
Dor Abdominal/etiologia , Apendicite/diagnóstico , Situs Inversus/diagnóstico , Adulto , Erros de Diagnóstico , Gastroenterite/diagnóstico , Humanos , Masculino , Mucocele/diagnóstico
10.
BMJ Case Rep ; 20182018 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-30317204

RESUMO

Liver transplantation for biliary atresia splenic malformation syndrome associated with situs inversus totalis is a challenging task due to the complexity of associated malformations and the technical proficiency required to overcome them. We present the case of a 6-month-old infant who underwent liver transplantation for biliary atresia. A reduced left lateral segment liver graft from a live donor (his mother) was implanted. The postoperative period was uneventful, and the child remained well on follow-up. Thus, such rare congenital anomalies no longer prove to be a deterrent for successful liver transplantation.


Assuntos
Atresia Biliar/diagnóstico , Transplante de Fígado , Situs Inversus/diagnóstico , Anormalidades Múltiplas/diagnóstico , Anormalidades Múltiplas/diagnóstico por imagem , Anormalidades Múltiplas/cirurgia , Atresia Biliar/complicações , Atresia Biliar/diagnóstico por imagem , Atresia Biliar/cirurgia , Diagnóstico Diferencial , Humanos , Lactente , Doadores Vivos , Masculino , Situs Inversus/complicações , Situs Inversus/diagnóstico por imagem , Situs Inversus/cirurgia , Tomografia Computadorizada por Raios X
11.
J Electrocardiol ; 51(4): 634-636, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29997003

RESUMO

A 25 year old lady presented with palpitation to the emergency department. Her pulse rate was 210 beats per minute. She was hemodynamically stable with a blood pressure of 100/60 mm Hg. 12 lead surface electrocardiogram (ECG) was recorded during the presentation (Fig. 1) and rhythm strip (Fig. 2A) during administration of IV adenosine. What is the likely diagnosis?


Assuntos
Eletrocardiografia , Situs Inversus/diagnóstico , Taquicardia por Reentrada no Nó Atrioventricular/diagnóstico , Adenosina/farmacologia , Adulto , Antiarrítmicos/farmacologia , Dextrocardia/diagnóstico por imagem , Eletrocardiografia/efeitos dos fármacos , Feminino , Coração/diagnóstico por imagem , Frequência Cardíaca , Humanos , Radiografia Torácica , Situs Inversus/complicações , Taquicardia/etiologia , Taquicardia por Reentrada no Nó Atrioventricular/complicações
12.
Congenit Heart Dis ; 13(4): 624-627, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30033669

RESUMO

PATIENTS: We reviewed all patients evaluated at our center with situs solitus, levocardia, and a right aortic arch that were born between January 2000 and January 2018. RESULTS: From our databases, we identified 204 patients. We excluded patients with a double aortic arch from analysis. Of the 204 patients, 103 (50%) were male. Of the 204 patients, 95 (47%) had an isolated right aortic arch. Of the 95 with an isolated right aortic arch, 4 (4%) had chromosome 22q11.2 deletion syndrome, and 89 (94%) had a vascular ring. Of the 204 patients, 109 (53%) had a surgical intracardiac malformation. Of the 109, with an associated surgical intracardiac malformation, 38 (35%) had chromosome 22q11.2 deletion syndrome, and 28 (26%) had a vascular ring. Overall, of the 204 patients, 200 (98%) had a vascular ring, an associated intracardiac malformation, or both. Prenatal detection was 85% (40/47) for the subset of patients born in Southern Nevada between January 2015 and January 2018. CONCLUSION: this review, to best of our knowledge, reports one of largest series of right aortic arches in the literature. Data from our cohort demonstrates that a right aortic arch in situs solitus is almost always associated with pathology. Further, our center's right aortic arch prenatal detection rate exceeds previous reports.


Assuntos
Anormalidades Múltiplas , Aorta Torácica/anormalidades , Situs Inversus/diagnóstico , Malformações Vasculares/diagnóstico , Diagnóstico Diferencial , Ecocardiografia , Feminino , Humanos , Recém-Nascido , Imagem Cinética por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios X
14.
Cardiol Young ; 28(5): 759-761, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29428001

RESUMO

Congenitally corrected transposition of the great arteries is a rare form of CHD. Situs inversus is a much less common variant of a congenitally corrected transposition of the great arteries. In rare cases, transposition events may be accompanied by various cardiac anomalies. However, situs inversus patients with congenitally corrected transposition, single coronary artery anomaly, and atrioventricular block together have not been reported previously. This combination of abnormalities is presented as a first in the literature.


Assuntos
Anormalidades Múltiplas , Bloqueio Atrioventricular/diagnóstico , Anomalias dos Vasos Coronários/diagnóstico , Doenças Raras , Situs Inversus/diagnóstico , Transposição dos Grandes Vasos/diagnóstico , Adulto , Bloqueio Atrioventricular/congênito , Bloqueio Atrioventricular/fisiopatologia , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Ecocardiografia , Eletrocardiografia , Humanos , Masculino
15.
J Med Case Rep ; 12(1): 5, 2018 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-29316973

RESUMO

BACKGROUND: Kartagener's syndrome is a subset of primary ciliary dyskinesia, an autosomal recessive inherited disorder characterized by the clinical triad of chronic sinusitis, bronchiectasis, and situs inversus. Abnormal ciliary structure or function leading to impaired ciliary motility is the main pathophysiologic problem in Kartagener's syndrome. CASE PRESENTATION: A 24-year-old man from Gondar town, North-West Ethiopia, presented to University of Gondar Hospital with recurrent episodes of nasal congestion with itching and paranasal discomfort, and productive cough for more than a decade. Clinical and imaging findings revealed chronic sinusitis, bronchiectasis, dextrocardia, and situs inversus. He was treated with orally administered antibiotics, mucolytic, and chest physiotherapy. He was symptomatically better with the above therapy, and started on a long-term low-dose prophylactic antibiotic. CONCLUSIONS: Patients with Kartagener's syndrome exist in Ethiopia as cases of chronic recurrent sinopulmonary infections. As there is no easy, reliable non-invasive diagnostic test for Kartagener's syndrome and the correct diagnosis is often delayed by years, it may cause chronic respiratory problems with reduced quality of life. Genetic counseling and fertility issues should be addressed once Kartagener's syndrome is diagnosed.


Assuntos
Antibacterianos/administração & dosagem , Bronquiectasia , Dextrocardia , Expectorantes/administração & dosagem , Síndrome de Kartagener , Qualidade de Vida , Sinusite , Situs Inversus , Exercícios Respiratórios/métodos , Bronquiectasia/diagnóstico , Bronquiectasia/etiologia , Bronquiectasia/fisiopatologia , Bronquiectasia/terapia , Doença Crônica , Dextrocardia/diagnóstico , Dextrocardia/etiologia , Diagnóstico Diferencial , Aconselhamento Genético , Humanos , Síndrome de Kartagener/diagnóstico , Síndrome de Kartagener/fisiopatologia , Síndrome de Kartagener/psicologia , Síndrome de Kartagener/terapia , Masculino , Administração dos Cuidados ao Paciente/métodos , Sinusite/diagnóstico , Sinusite/tratamento farmacológico , Sinusite/etiologia , Situs Inversus/diagnóstico , Situs Inversus/etiologia , Adulto Jovem
16.
Asian J Endosc Surg ; 11(1): 39-42, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28677888

RESUMO

Situs inversus totalis (SIT) is a rare congenital anomaly. Generally, laparoscopic surgery is difficult to perform in patients with SIT because of both the potential challenges associated with unexpected vascular anomalies and the lack of standardized strategy for handling such cases. This is the first report of laparoscopic total gastrectomy with lymph node dissection for advanced gastric cancer in a patient with SIT. A 79-year-old man with SIT was diagnosed with advanced gastric cancer. We performed laparoscopic total gastrectomy with modified D2 lymph node dissection (D2 without splenectomy) and esophagojejunal anastomosis using an overlap method involving retrocolic Roux-en-Y reconstruction. The total operating time was 232 min, and blood loss was 110 mL. There were no postoperative complications. In summary, laparoscopic total gastrectomy for gastric cancer can be performed safely, even in a patient with SIT.


Assuntos
Adenocarcinoma/cirurgia , Gastrectomia/métodos , Gastroscopia/métodos , Situs Inversus/diagnóstico , Neoplasias Gástricas/cirurgia , Tomografia Computadorizada por Raios X/métodos , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Idoso , Anastomose Cirúrgica , Perda Sanguínea Cirúrgica/fisiopatologia , Seguimentos , Humanos , Excisão de Linfonodo , Linfonodos/patologia , Masculino , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Duração da Cirurgia , Medição de Risco , Situs Inversus/complicações , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/patologia , Fatores de Tempo , Resultado do Tratamento
17.
Graefes Arch Clin Exp Ophthalmol ; 256(2): 333-340, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29242987

RESUMO

PURPOSE: To establish the prevalence and heritability of cilioretinal arteries (CRAs), tilted discs (TDs) and situs inversus (SI). METHODS: Fundus photos from the Twins UK Adult Twin registry twin database were analyzed: 1812 individuals, 526 complete monozygotic (MZ) twin pairs and 336 complete dizygotic (DZ) pairs. Images were assessed non-stereoscopically on a computer screen by the same ophthalmologist for presence of CRAs, TDs or SI. Prevalence figures, probandwise concordances and heritabilities were calculated. RESULTS: Prevalence of a CRA in subjects' right eyes was 28.6% (26.5-30.8). Prevalence of subjects with a CRA in at least one eye was 45.0% (42.6-47.5), with a TD in at least one eye was 1.2% (0.8-1.9), and with SI at least one eye was 0.5% (0.3-1.0). There was no association between birth weight and presence of CRA. Concordance for CRA in at least one eye (MZ twins) was 60% (95% CI 55-64), and (DZ) was 45% (95% CI 39-51). Heritability for CRAs in at least one eye was 49.4% (95% CI 38.1-59.7) and for both eyes was 32.9% (95% CI 10.4-53.3). We were unable to calculate meaningful heritabilities or concordances for TDs and situs SI, due to insufficient numbers. CONCLUSIONS: The presence of CRAs appears to be moderately heritable, with greater variance explained by individual environmental factors or even stochastic events. They were not associated with low birth weight. Future genetic research and studies of birth/lifecourse cohorts may offer further insights into the etiology of congenital papillovascular abnormalities.


Assuntos
Anormalidades Múltiplas , Artérias Ciliares/patologia , Doenças em Gêmeos/genética , Disco Óptico/anormalidades , Doenças do Nervo Óptico/genética , Artéria Retiniana/patologia , Situs Inversus/genética , Doenças em Gêmeos/diagnóstico , Feminino , Predisposição Genética para Doença , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Nervo Óptico/diagnóstico , Sistema de Registros , Situs Inversus/diagnóstico , Gêmeos Monozigóticos
18.
World J Pediatr Congenit Heart Surg ; 9(2): 254-256, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-27881809

RESUMO

Transposition of the great arteries occurs rarely in patients with mirror image dextrocardia and situs inversus, while the combination with severe coarctation of the descending aorta (CoA) makes the anatomy even more unusual. Therefore, it is not surprising that a case with such unusual and complicated anatomy presents unique problems when a primary definitive correction is attempted. We report a patient with situs inversus totalis and complex congenital heart disease including transposition of the great arteries and severe CoA who underwent successful complete, single-stage, anatomic correction.


Assuntos
Anormalidades Múltiplas/cirurgia , Coartação Aórtica/cirurgia , Situs Inversus/cirurgia , Transposição dos Grandes Vasos/cirurgia , Anormalidades Múltiplas/diagnóstico , Coartação Aórtica/diagnóstico , Humanos , Recém-Nascido , Masculino , Situs Inversus/diagnóstico , Transposição dos Grandes Vasos/diagnóstico
19.
Medicine (Baltimore) ; 96(49): e9028, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29245291

RESUMO

RATIONALE: Abdominal pain is one of the most common complaints for patients in emergency department. It's difficult to make an accurate diagnosis by emergency physician in time, especially in patients with situs inversus totalis. PATIENT CONCERNS: A patient with acute exacerbation of chronic left upper quadrant abdominal pain.DIAGNOSES:: cholangiolithiasis with situs inversus totalis. INTERVENTIONS: laparoscopic cholecystectomy and laparoscopic exploration of common bile duct. OUTCOMES: The patient had an uneventful recovery. LESSONS: High suspicion and adequate evaluation are important for diagnosis in patients with abdominal pain and situs inversus totalis in emergency department, and physical examination, electrocardiogrphy and radiological investigations are necessary.


Assuntos
Dor Abdominal/etiologia , Doenças dos Ductos Biliares/complicações , Litíase/complicações , Situs Inversus/complicações , Situs Inversus/diagnóstico , Doenças dos Ductos Biliares/cirurgia , Diagnóstico Tardio , Serviço Hospitalar de Emergência , Feminino , Humanos , Litíase/cirurgia , Pessoa de Meia-Idade
20.
Medicine (Baltimore) ; 96(39): e8209, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28953685

RESUMO

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.


Assuntos
Adenocarcinoma in Situ , Junção Esofagogástrica/patologia , Gastrectomia/métodos , Cuidados Pré-Operatórios/métodos , Situs Inversus , Neoplasias Gástricas , Adenocarcinoma in Situ/patologia , Adenocarcinoma in Situ/fisiopatologia , Adenocarcinoma in Situ/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Anormalidades do Sistema Digestório/diagnóstico , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Robóticos/métodos , Situs Inversus/diagnóstico , Situs Inversus/fisiopatologia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/fisiopatologia , Neoplasias Gástricas/cirurgia , Resultado do Tratamento , Malformações Vasculares/diagnóstico
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