Situs inversus totalis(SIT)is a rare congenital anomaly in which the major organs are reversed from their normal positions.In patients with SIT,the right-lobe graft must be placed in the left upper quadrant(LUQ).Howev...Situs inversus totalis(SIT)is a rare congenital anomaly in which the major organs are reversed from their normal positions.In patients with SIT,the right-lobe graft must be placed in the left upper quadrant(LUQ).However,hepatic outflow obstruction is a critical issue,often requiring radiologic intervention because of compression or kinking following graft regeneration of the vessels[1–3].Therefore,preoperative planning is essential to address the challenges of graft placement and vein reconstruction.Despite these complexities,we previously reported techniques using a reversed modified right-lobe(mRL)graft from a donor in a conventional recipient with SIT[2].Here,we successfully applied a similar concept.展开更多
BACKGROUND Situs inversus viscerum(SIV)is a rare autosomal recessive genetic disorder characterized a complete mirror-image organ reversal in the thoracic and abdo-minal cavities.Its low incidence presents considerabl...BACKGROUND Situs inversus viscerum(SIV)is a rare autosomal recessive genetic disorder characterized a complete mirror-image organ reversal in the thoracic and abdo-minal cavities.Its low incidence presents considerable challenges in clinical dia-gnosis and treatment,especially concerning gastrointestinal endoscopic proce-dures.CASE SUMMARY Herein,we report a case of an 80-year-old male with choledocholithiasis and acute obstructive empyematous cholangitis.Imaging revealed total visceral inversion in the patient.Endoscopic retrograde cholangiopancreatography(ERCP)was successfully performed to remove the stones,resulting to substantial relief of clinical symptoms and gradual improvement of the patient’s condition,leading to successful recovery and discharge.CONCLUSION Therapeutic ERCP is a safe and effective surgical option for patients with SIV.The main focus for successful ERCP in patients with SIV includes positioning adju-stments during the surgical process and using the dual-guidewire technique for biliary cannulation.展开更多
As among persons with normal anatomy, occasional patients with situs inversus develop malignant tumors. Recently, several laparoscopic operations have been reported in patients with situs inversus. We describe laparos...As among persons with normal anatomy, occasional patients with situs inversus develop malignant tumors. Recently, several laparoscopic operations have been reported in patients with situs inversus. We describe laparoscopic hemicolectomy with radical lymphadenectomy in such a patient. Careful consideration of the mirror-image anatomy permitted safe operation using techniques not otherwise differing from those in ordinary cases. Thus, curative laparoscopic surgery for colon cancer in the presence of situs inversus is feasible and safe.展开更多
A 76-year-old man with known situs inversus totalis presented with leE-sided discomfort. Abdominal ultrasonography and CT scan confirmed the diagnosis of a gallstone, as well as, situs inversus; the liver and gallblad...A 76-year-old man with known situs inversus totalis presented with leE-sided discomfort. Abdominal ultrasonography and CT scan confirmed the diagnosis of a gallstone, as well as, situs inversus; the liver and gallbladder on the left side and the spleen on the right. The biliary system was thought to be left-right reversal, mirror image in the view of drip infusion cholangiogram and MRI. Laparoscopic cholecy stectomy was safely performed, despite of unexpected aberrant cystic artery running inferior to cystic duct of situs inversus. Laparoscopic surgeon should be careful for view of reversed relationships and also existence of other anomalies.展开更多
BACKGROUND Situs inversus totalis(SIT)is a rare anomaly in which structures are located opposite to their usual positions.It is not a premalignant condition and the association with colorectal cancer(CRC)is rare.We he...BACKGROUND Situs inversus totalis(SIT)is a rare anomaly in which structures are located opposite to their usual positions.It is not a premalignant condition and the association with colorectal cancer(CRC)is rare.We here report a patient with SIT who underwent laparoscopic radical resection of sigmoid colon cancer,and review the pertinent literature.CASE SUMMARY A 53-year-old woman presented with CRC and SIT and underwent a complete examination after admission.The patient then underwent laparoscopic radical resection of sigmoid colon cancer and hyperthermic intraperitoneal chemotherapy.The operation duration was 120 min,and no intraoperative complications occurred.The final pathological report showed stage T4aN0M0.Postoperative chemotherapy was administered and no evidence of recurrence was observed during 18 mo of follow-up.CONCLUSION Surgery in a patient with CRC and SIT can be safely performed on the basis of routine preoperative clinical examination.展开更多
Situs inversus(SI)is a rare congenital condition characterized by a mirror-image transposition of the major visceral organs.Since the 1990s,more than one hundred SI patients have been reported to have successfully und...Situs inversus(SI)is a rare congenital condition characterized by a mirror-image transposition of the major visceral organs.Since the 1990s,more than one hundred SI patients have been reported to have successfully undergone laparoscopic cholecystectomy.In these cases,the major problem is to overcome is the left-right condition for right-handed surgeons.Laparoscopic common bile duct exploration(LCBDE),an alternative to treat patients with bile duct stones,has shown equivalent efficacy and is less likely to cause pancreatitis than endoscopic retrograde cholangiopancreatography.Recent updated meta-analyses revealed that a shorter postoperative hospital stay,fewer procedural interventions,cost-effectiveness,a higher stone clearance rate,and fewer perioperative complications are additional advantages of LCBDE.However,the technique is technically demanding,even for skilled laparoscopic surgeons.Conducting LCBDE in patients with difficult situations,such as SI,is more complex than usual.We herein review published SI patients with choledocholithiasis treated by LCBDE,including our own experience,and this paper focuses on the technical aspects.展开更多
BACKGROUND Situs inversus totalis(SIT)is an extremely rare congenital malformation characterized by mirror displacement of the thoracoabdominal organs such as the heart,liver,spleen,and stomach.Herein,we describe a pa...BACKGROUND Situs inversus totalis(SIT)is an extremely rare congenital malformation characterized by mirror displacement of the thoracoabdominal organs such as the heart,liver,spleen,and stomach.Herein,we describe a patient with SIT complicated with cholangiocarcinoma who underwent successful pancreaticoduodenectomy with the assistance of a da Vinci robot.CASE SUMMARY A 58-year-old female presented to the hospital with paroxysmal pain in her left upper abdomen,accompanied by jaundice and staining of the sclera as chief complaints.Imaging examination detected a mass at the distal end of the common bile duct,with inverted thoracic and abdominal organs.Endoscopic retrograde cholangiopancreatography forceps biopsy revealed the presence of a well-differentiated adenocarcinoma.The patient successfully underwent robotic-assisted pancreaticoduodenectomy;the operation lasted 300 min,the intraoperative blood loss was 500 mL,and there were no intraoperative and postoperative complications.CONCLUSION SIT is not directly related to the formation of cholangiocarcinoma.Detailed preoperative imaging examination is conducive to disease diagnosis and also convenient for determining the feasibility of tumor resection.Robot-assisted pancreaticoduodenectomy for SIT complicated with cholangiocarcinoma provides a safe,feasible,minimally invasive,and complication-free alternative with adequate preoperative planning combined with meticulous intraoperative procedures.展开更多
Currently, laparoscopic cholecystectomy is an undoubtfully optimal treatment of cholelithiasis. What about performing this procedure on a patient with situs inversus totalis and what are the difficulties of this opera...Currently, laparoscopic cholecystectomy is an undoubtfully optimal treatment of cholelithiasis. What about performing this procedure on a patient with situs inversus totalis and what are the difficulties of this operation for a right-handed surgeon? We presented a 35-year-old man with unknown situs inversus totalis who was admitted with epigastric pain and digestive problems. Ultrasonography and computed tomography of the abdomen confirmed the diagnosis of a gallstone. Besides, the liver and gallbladder were on the left side and the spleen was on the right. All systems were left-right reversal as mirror image in all diagnostic studies. Laparoscopic cholecystectomy was safely performed, despite of difficulties of situs inversus. The patient was discharged on postoperative day 1. It should be considered that existence of other anomalies may easily cause uninvited injuries. In the patients with situs inversus, laparoscopic cholecystectomy can be safely managed by an experienced surgeon through laparoscopy, and also hepatobiliary surgery.展开更多
BACKGROUND Situs inversus totalis(SIT)is a rare congenital anomaly that refers to a completely reversed location of abdominal and thoracic organs.An extremely small number of patients with this condition,especially th...BACKGROUND Situs inversus totalis(SIT)is a rare congenital anomaly that refers to a completely reversed location of abdominal and thoracic organs.An extremely small number of patients with this condition,especially those with rectal neoplasms,have been reported.Surgery in these patients is technically challenging.Therefore,we reconstructed a three-dimensional(3D)digital model with the Materialise’s interactive medical image control system(Mimics)as a guide for laparoscopic resection.CASE SUMMARY We report the case of a 68-year-old woman with rectal neoplasms and SIT diagnosed by electronic colonoscopy biopsy and enhanced computed tomography(CT),which showed that there was a soft tissue mass protruding into the lumen in the lower rectal segment,a lesion that involved the serosal layer,multiple enlarged peripheral lymph nodes,and visceral situs abnormalities.Based on the CT images,we reconstructed a 3D model with Mimics to assist with our surgical planning.Then,we performed laparoscopyassisted radical resection of the rectal neoplasms and total excision of the lesion.Adjuvant chemotherapy with the XELOX regimen(oxaliplatin 150 mg,D1+Xeloda 1.0 g,Bid,D1-14)was initiated 1 mo after the operation.The patient recovered well after surgery,and her physical condition remained stable.CONCLUSION Preoperative 3D reconstruction of the imaging results could help reduce the unknown risks during surgery caused by anatomical abnormalities and improvethe perioperative safety for patients.展开更多
BACKGROUND Situs inversus totalis(SIT)is a rare congenital condition in which the structure of the abdominal and thoracic cavities is the mirror image of normal.This anatomic reversal makes laparoscopic surgery diffic...BACKGROUND Situs inversus totalis(SIT)is a rare congenital condition in which the structure of the abdominal and thoracic cavities is the mirror image of normal.This anatomic reversal makes laparoscopic surgery difficult when treating colorectal cancer.CASE SUMMARY We describe the successful laparoscopic hemicolectomy of a 68-year-old Chinese woman with SIT and ascending colon cancer.Based on preoperative imaging and careful consideration of the patient’s anatomy,the position of the surgeon was modified such that the surgeon stood between her legs,while the surgical assistant and endoscopist stood to the surgeon’s left.Trocar position was also adjusted appropriately.The surgery lasted 178 min,during which the patient lost 50 mL of blood.Pathology analysis of the resected tumor confirmed an adenocarcinoma in clinical stage pT3N0M0,without lymph node involvement.The patient experienced no postoperative complications and was discharged 10 d after surgery.CONCLUSION This case illustrates that careful positioning of the surgeon can facilitate laparoscopic surgery of SIT patients.展开更多
Situs inversus abdominus with rotational anomaly of the intestines is an extremely rare condition. Although intestinal malrotation has been recognized as a cause of obstruction in infants and children and may be compl...Situs inversus abdominus with rotational anomaly of the intestines is an extremely rare condition. Although intestinal malrotation has been recognized as a cause of obstruction in infants and children and may be complicated by intestinal ischaemia, it is very rare in adults. When it occurs in the adult patient, it may present acutely as bowel obstruction or intestinal ischaemia or chronically as vague intermittent abdominal pain. Herein, we present an acute presentation of a case of situs inversus abdominus and intestinal malrotation with Ladd＇s band leading to infarction of the intestine in a 32 year old woman.展开更多
BACKGROUND Situs inversus totalis(SIT)is a rare condition in which the positions of abdominal and thoracic organs present a“mirror image”of the normal ones in the median sagittal plane.Although minimally invasive su...BACKGROUND Situs inversus totalis(SIT)is a rare condition in which the positions of abdominal and thoracic organs present a“mirror image”of the normal ones in the median sagittal plane.Although minimally invasive surgery has evolved to achieve laparoscopic gastrectomy for gastric cancer(GC)patients with SIT,it is difficult to perform lymphadenectomy(LND)in such a transposed anatomical condition.Herein,we report the cases of two patients with SIT who successfully underwent laparoscopy-assisted gastrectomy(LAG)with D2 LND.CASE SUMMARY Case 1:A 65-year-old man was admitted for intermittent abdominal pain and distension,occasional belching,and acid reflux for 4 mo.He was diagnosed with GC(cT3N1-2M0)with SIT.Before surgery,he had undergone four cycles of neoadjuvant chemotherapy and immunotherapy.Then,the patient was evaluated as having a partial response,and laparoscopy-assisted distal gastrectomy with D2 LND and Billroth II reconstruction were performed.The operation was performed successfully within 240 min with an estimated blood loss of 50 mL and no severe complications.The patient was discharged on postoperative day(POD)9.Case 2:A 55-year-old man was admitted for upper abdominal distension with pain and discomfort after eating for 3 mo.He was diagnosed with GC(cT3N1M0)with SIT.He had a history of hypertension for more than 10 years;however,his blood pressure was well-controlled via regular medication.We performed laparoscopy-assisted total gastrectomy with D2 LND and Roux-en-Y reconstruction.The operation was performed successfully within 168 min with an estimated blood loss of 50 mL and no severe complications.The patient was discharged on POD 10.CONCLUSION LAG with D2 LND could be considered an accessible,safe,and curative procedure for advanced GC patients with SIT.展开更多
BACKGROUND Congenital tuberculosis(TB),tuberculous meningitis,and situs inversus totalis are rare diseases.We here report a patient who simultaneously suffered from these three rare diseases.There is currently no such...BACKGROUND Congenital tuberculosis(TB),tuberculous meningitis,and situs inversus totalis are rare diseases.We here report a patient who simultaneously suffered from these three rare diseases.There is currently no such report in the literature.Congenital TB is easily misdiagnosed and has a high case fatality rate.Timely anti-TB treatment is required.CASE SUMMARY A 19-day-old male newborn was admitted to hospital due to a fever for 6 h.His blood tests and chest X-rays suggested infection,and he was initially considered to have neonatal pneumonia and sepsis.He did not respond to conventional antiinfective treatment.Finally,Mycobacterium tuberculosis was found in sputum lavage fluid on the 10th day after admission.In addition,the mother's tuberculin skin test was positive,with an induration of 22 mm,and her pelvic computed tomography scan suggested the possibility of tuberculous pelvic inflammatory disease.The child was diagnosed with congenital TB and immediately managed with anti-TB therapy and symptomatic supportive treatment.However,the infant's condition gradually worsened and he developed severe tuberculous pneumonia and tuberculous meningitis,and eventually died of respiratory failure.CONCLUSION If conventional anti-infective treatment is ineffective in neonatal pneumonia,anti-TB treatment should be considered.展开更多
BACKGROUND Situs inversus totalis(SIT)is a rare group of congenital developmental malformations in the clinical setting,with all organs in the chest and abdomen existing in a mirror image reversal of their normal posi...BACKGROUND Situs inversus totalis(SIT)is a rare group of congenital developmental malformations in the clinical setting,with all organs in the chest and abdomen existing in a mirror image reversal of their normal positions.Few reports have described laparoscopic surgery for colorectal cancer in patients with SIT,and it is considered difficult even for an experienced surgeon because of the mirror positioning.We present a case report of laparoscopic radical resection of a colonic splenic flexure carcinoma in a patient with SIT.CASE SUMMARY A 72-year-old male was referred to our hospital with colonic splenic flexure carcinoma,and computed tomography showed that all the organs in the chest and abdomen were inverted.Laparoscopic hemicolectomy with complete mesocolic excision was safely performed.The operating surgeon stood on the patient’s left side,which is opposite of the normal location.CONCLUSION Abdominal computed tomography is an effective method for diagnosing SIT preoperatively in patients with colonic splenic flexure carcinomas.Laparoscopic radical resection is difficult,but it is well established and safe.The surgeon should stand in the opposite position and perform backhand operations.展开更多
Hepatocellular carcinoma(HCC)is the most commonly diagnosed carcinoma and one of the leading causes of cancer-related deaths worldwide.Situs inversus totalis(SIT)is a congenital condition where in the internal organs ...Hepatocellular carcinoma(HCC)is the most commonly diagnosed carcinoma and one of the leading causes of cancer-related deaths worldwide.Situs inversus totalis(SIT)is a congenital condition where in the internal organs of the abdomen and thorax lie in mirror images of their normal position.Thus far,there are very few reports on cases of SIT coexisting with HCC.Our case series is probably the largest series in world literature.The cohort of this retrospective study included a total of nine patients diagnosed with SIT-HCC and treated in our hospital between January 2013 and May 2018.Clinical characteristics,prognostic factors,and outcomes were summarized.Treatment strategies included surgery,transarterial chemoembolization,and microwave ablation.The diagnosis and treatment of patients with SIT are challenging because of organ reversion.The current treatment strategies for different stages of liver cancer are safe and feasible for patients with SIT-HCC.展开更多
BACKGROUND Single atrium with single ventricle,or a two-chambered heart,is an extremely rare congenital malformation.Few cases with two-chambered heart surviving to adulthood have been reported.CASE SUMMARY We reporte...BACKGROUND Single atrium with single ventricle,or a two-chambered heart,is an extremely rare congenital malformation.Few cases with two-chambered heart surviving to adulthood have been reported.CASE SUMMARY We reported an adult female patient with a two-chambered heart and situs inversus totalis accompanied by multiple pregnancies and abortions.Magnetic resonance imaging detected a two-chambered heart.B-ultrasound-guided uterine aspiration was performed to absorb 8 g and 10 g of organized villus and decidual tissues,respectively,with a small amount of bleeding.Postoperatively,cyanosis and fatigue-induced shortness of breath were gradually relieved.The patient has currently outlived all similar cases reported so far.CONCLUSION Hemodynamic changes in pregnant women with two-chambered heart impaired cardiac function,responsible for hypoperfusion and miscarriage.展开更多
This recipient with situs inversus totalis(SIT) was a 60-year-old female who had hepatitis B-related endstage liver disease.Preoperative donor evaluation showed that the right posterior section satisfied graft volume ...This recipient with situs inversus totalis(SIT) was a 60-year-old female who had hepatitis B-related endstage liver disease.Preoperative donor evaluation showed that the right posterior section satisfied graft volume and was space-fitting in the recipient hepatic fossa when it was rotated 180 degrees.The operation and postoperative course progressed satisfactorily.Three weeks after living donor liver transplantation(LDLT),the graft function was disturbed by compression of bottom-placed right hepatic vein.This was treated with a vascular stent and subsequently the graft function was normalized.The present case shows that LDLT for patients with SIT using a right posterior section graft is feasible.展开更多
A 26-year-old patient with mirror-image dextrocardia and situs inversus experienced a transient ischemic attack.We suspected that a patent foramen ovale was the reason.A Cardi-O-Fix occluder was used to close the pate...A 26-year-old patient with mirror-image dextrocardia and situs inversus experienced a transient ischemic attack.We suspected that a patent foramen ovale was the reason.A Cardi-O-Fix occluder was used to close the patent foramen ovale with a mirror-reversed rotation of the radiologic views.During the 18-month follow-up,no symptoms of the transient ischemic attack appeared again.展开更多
Correction to"Laparoscopy-assisted resection of colorectal cancer with situs inversus totalis:A case report and literature review"World J Gastrointest Endosc 2020;12:310-316.In this article,we have replaced ...Correction to"Laparoscopy-assisted resection of colorectal cancer with situs inversus totalis:A case report and literature review"World J Gastrointest Endosc 2020;12:310-316.In this article,we have replaced the previous TNM stage of colorectal cancer(T4aN0M0)and the revised TNM stage is provided(T4a-N1cM1c).展开更多
<b>Introduction:</b> Left-sided acute appendicitis (LSAA) develops in association with two types of congenital anomalies: situs inversus totalis (SIT) and midgut malrotation (MM). A Left sided appendicitis...<b>Introduction:</b> Left-sided acute appendicitis (LSAA) develops in association with two types of congenital anomalies: situs inversus totalis (SIT) and midgut malrotation (MM). A Left sided appendicitis is an ambiguous and difficult diagnosis to make. <b>Aim: </b>To present a proven case of left-sided acute appendicitis (LSAA) associated with situs inversus totalis (SIT). <b>Case</b> <b>Report:</b> A case of Left appendicitis was evaluated in a 28-year-old Asian male, who presented to our hospital in Feb. 2016, with lower abdominal pain more on left side and suspected diverticulitis or acute appendicitis with unusual appendix location. The patient doesn’t recall any history of abdominal surgery or about situs inversus totalis, abdominal and pelvic ultrasound was done, left iliac fossa appendicitis was diagnosed, Erect chest X-ray including upper abdomen revealed dextrocardia and stomach air on right side (situs inversus totalis), the patient underwent diagnostic Laproscop and Endoscopic resection of the appendix, with no incidents, and then discharged without complications, follow visits went unremarkable. <b>Conclusion: </b>The diagnosis of left lower quadrant pain is based on well-established clinical symptoms, physical examination and physician’s experience.展开更多
文摘Situs inversus totalis(SIT)is a rare congenital anomaly in which the major organs are reversed from their normal positions.In patients with SIT,the right-lobe graft must be placed in the left upper quadrant(LUQ).However,hepatic outflow obstruction is a critical issue,often requiring radiologic intervention because of compression or kinking following graft regeneration of the vessels[1–3].Therefore,preoperative planning is essential to address the challenges of graft placement and vein reconstruction.Despite these complexities,we previously reported techniques using a reversed modified right-lobe(mRL)graft from a donor in a conventional recipient with SIT[2].Here,we successfully applied a similar concept.
文摘BACKGROUND Situs inversus viscerum(SIV)is a rare autosomal recessive genetic disorder characterized a complete mirror-image organ reversal in the thoracic and abdo-minal cavities.Its low incidence presents considerable challenges in clinical dia-gnosis and treatment,especially concerning gastrointestinal endoscopic proce-dures.CASE SUMMARY Herein,we report a case of an 80-year-old male with choledocholithiasis and acute obstructive empyematous cholangitis.Imaging revealed total visceral inversion in the patient.Endoscopic retrograde cholangiopancreatography(ERCP)was successfully performed to remove the stones,resulting to substantial relief of clinical symptoms and gradual improvement of the patient’s condition,leading to successful recovery and discharge.CONCLUSION Therapeutic ERCP is a safe and effective surgical option for patients with SIV.The main focus for successful ERCP in patients with SIV includes positioning adju-stments during the surgical process and using the dual-guidewire technique for biliary cannulation.
文摘As among persons with normal anatomy, occasional patients with situs inversus develop malignant tumors. Recently, several laparoscopic operations have been reported in patients with situs inversus. We describe laparoscopic hemicolectomy with radical lymphadenectomy in such a patient. Careful consideration of the mirror-image anatomy permitted safe operation using techniques not otherwise differing from those in ordinary cases. Thus, curative laparoscopic surgery for colon cancer in the presence of situs inversus is feasible and safe.
文摘A 76-year-old man with known situs inversus totalis presented with leE-sided discomfort. Abdominal ultrasonography and CT scan confirmed the diagnosis of a gallstone, as well as, situs inversus; the liver and gallbladder on the left side and the spleen on the right. The biliary system was thought to be left-right reversal, mirror image in the view of drip infusion cholangiogram and MRI. Laparoscopic cholecy stectomy was safely performed, despite of unexpected aberrant cystic artery running inferior to cystic duct of situs inversus. Laparoscopic surgeon should be careful for view of reversed relationships and also existence of other anomalies.
文摘BACKGROUND Situs inversus totalis(SIT)is a rare anomaly in which structures are located opposite to their usual positions.It is not a premalignant condition and the association with colorectal cancer(CRC)is rare.We here report a patient with SIT who underwent laparoscopic radical resection of sigmoid colon cancer,and review the pertinent literature.CASE SUMMARY A 53-year-old woman presented with CRC and SIT and underwent a complete examination after admission.The patient then underwent laparoscopic radical resection of sigmoid colon cancer and hyperthermic intraperitoneal chemotherapy.The operation duration was 120 min,and no intraoperative complications occurred.The final pathological report showed stage T4aN0M0.Postoperative chemotherapy was administered and no evidence of recurrence was observed during 18 mo of follow-up.CONCLUSION Surgery in a patient with CRC and SIT can be safely performed on the basis of routine preoperative clinical examination.
文摘Situs inversus(SI)is a rare congenital condition characterized by a mirror-image transposition of the major visceral organs.Since the 1990s,more than one hundred SI patients have been reported to have successfully undergone laparoscopic cholecystectomy.In these cases,the major problem is to overcome is the left-right condition for right-handed surgeons.Laparoscopic common bile duct exploration(LCBDE),an alternative to treat patients with bile duct stones,has shown equivalent efficacy and is less likely to cause pancreatitis than endoscopic retrograde cholangiopancreatography.Recent updated meta-analyses revealed that a shorter postoperative hospital stay,fewer procedural interventions,cost-effectiveness,a higher stone clearance rate,and fewer perioperative complications are additional advantages of LCBDE.However,the technique is technically demanding,even for skilled laparoscopic surgeons.Conducting LCBDE in patients with difficult situations,such as SI,is more complex than usual.We herein review published SI patients with choledocholithiasis treated by LCBDE,including our own experience,and this paper focuses on the technical aspects.
文摘BACKGROUND Situs inversus totalis(SIT)is an extremely rare congenital malformation characterized by mirror displacement of the thoracoabdominal organs such as the heart,liver,spleen,and stomach.Herein,we describe a patient with SIT complicated with cholangiocarcinoma who underwent successful pancreaticoduodenectomy with the assistance of a da Vinci robot.CASE SUMMARY A 58-year-old female presented to the hospital with paroxysmal pain in her left upper abdomen,accompanied by jaundice and staining of the sclera as chief complaints.Imaging examination detected a mass at the distal end of the common bile duct,with inverted thoracic and abdominal organs.Endoscopic retrograde cholangiopancreatography forceps biopsy revealed the presence of a well-differentiated adenocarcinoma.The patient successfully underwent robotic-assisted pancreaticoduodenectomy;the operation lasted 300 min,the intraoperative blood loss was 500 mL,and there were no intraoperative and postoperative complications.CONCLUSION SIT is not directly related to the formation of cholangiocarcinoma.Detailed preoperative imaging examination is conducive to disease diagnosis and also convenient for determining the feasibility of tumor resection.Robot-assisted pancreaticoduodenectomy for SIT complicated with cholangiocarcinoma provides a safe,feasible,minimally invasive,and complication-free alternative with adequate preoperative planning combined with meticulous intraoperative procedures.
文摘Currently, laparoscopic cholecystectomy is an undoubtfully optimal treatment of cholelithiasis. What about performing this procedure on a patient with situs inversus totalis and what are the difficulties of this operation for a right-handed surgeon? We presented a 35-year-old man with unknown situs inversus totalis who was admitted with epigastric pain and digestive problems. Ultrasonography and computed tomography of the abdomen confirmed the diagnosis of a gallstone. Besides, the liver and gallbladder were on the left side and the spleen was on the right. All systems were left-right reversal as mirror image in all diagnostic studies. Laparoscopic cholecystectomy was safely performed, despite of difficulties of situs inversus. The patient was discharged on postoperative day 1. It should be considered that existence of other anomalies may easily cause uninvited injuries. In the patients with situs inversus, laparoscopic cholecystectomy can be safely managed by an experienced surgeon through laparoscopy, and also hepatobiliary surgery.
基金Supported by the State’s Key Project of Research and Development Plan,No.2017YFC0108300 and No.2017YFC0108303
文摘BACKGROUND Situs inversus totalis(SIT)is a rare congenital anomaly that refers to a completely reversed location of abdominal and thoracic organs.An extremely small number of patients with this condition,especially those with rectal neoplasms,have been reported.Surgery in these patients is technically challenging.Therefore,we reconstructed a three-dimensional(3D)digital model with the Materialise’s interactive medical image control system(Mimics)as a guide for laparoscopic resection.CASE SUMMARY We report the case of a 68-year-old woman with rectal neoplasms and SIT diagnosed by electronic colonoscopy biopsy and enhanced computed tomography(CT),which showed that there was a soft tissue mass protruding into the lumen in the lower rectal segment,a lesion that involved the serosal layer,multiple enlarged peripheral lymph nodes,and visceral situs abnormalities.Based on the CT images,we reconstructed a 3D model with Mimics to assist with our surgical planning.Then,we performed laparoscopyassisted radical resection of the rectal neoplasms and total excision of the lesion.Adjuvant chemotherapy with the XELOX regimen(oxaliplatin 150 mg,D1+Xeloda 1.0 g,Bid,D1-14)was initiated 1 mo after the operation.The patient recovered well after surgery,and her physical condition remained stable.CONCLUSION Preoperative 3D reconstruction of the imaging results could help reduce the unknown risks during surgery caused by anatomical abnormalities and improvethe perioperative safety for patients.
文摘BACKGROUND Situs inversus totalis(SIT)is a rare congenital condition in which the structure of the abdominal and thoracic cavities is the mirror image of normal.This anatomic reversal makes laparoscopic surgery difficult when treating colorectal cancer.CASE SUMMARY We describe the successful laparoscopic hemicolectomy of a 68-year-old Chinese woman with SIT and ascending colon cancer.Based on preoperative imaging and careful consideration of the patient’s anatomy,the position of the surgeon was modified such that the surgeon stood between her legs,while the surgical assistant and endoscopist stood to the surgeon’s left.Trocar position was also adjusted appropriately.The surgery lasted 178 min,during which the patient lost 50 mL of blood.Pathology analysis of the resected tumor confirmed an adenocarcinoma in clinical stage pT3N0M0,without lymph node involvement.The patient experienced no postoperative complications and was discharged 10 d after surgery.CONCLUSION This case illustrates that careful positioning of the surgeon can facilitate laparoscopic surgery of SIT patients.
文摘Situs inversus abdominus with rotational anomaly of the intestines is an extremely rare condition. Although intestinal malrotation has been recognized as a cause of obstruction in infants and children and may be complicated by intestinal ischaemia, it is very rare in adults. When it occurs in the adult patient, it may present acutely as bowel obstruction or intestinal ischaemia or chronically as vague intermittent abdominal pain. Herein, we present an acute presentation of a case of situs inversus abdominus and intestinal malrotation with Ladd＇s band leading to infarction of the intestine in a 32 year old woman.
基金Supported by National Natural Science Foundation of China,No.81401515Zhongnan Hospital of Wuhan University Science Technology and Innovation Seed Fund,No.znpy2018030“351Talent Project(Luojia Young Scholars)”of Wuhan University.
文摘BACKGROUND Situs inversus totalis(SIT)is a rare condition in which the positions of abdominal and thoracic organs present a“mirror image”of the normal ones in the median sagittal plane.Although minimally invasive surgery has evolved to achieve laparoscopic gastrectomy for gastric cancer(GC)patients with SIT,it is difficult to perform lymphadenectomy(LND)in such a transposed anatomical condition.Herein,we report the cases of two patients with SIT who successfully underwent laparoscopy-assisted gastrectomy(LAG)with D2 LND.CASE SUMMARY Case 1:A 65-year-old man was admitted for intermittent abdominal pain and distension,occasional belching,and acid reflux for 4 mo.He was diagnosed with GC(cT3N1-2M0)with SIT.Before surgery,he had undergone four cycles of neoadjuvant chemotherapy and immunotherapy.Then,the patient was evaluated as having a partial response,and laparoscopy-assisted distal gastrectomy with D2 LND and Billroth II reconstruction were performed.The operation was performed successfully within 240 min with an estimated blood loss of 50 mL and no severe complications.The patient was discharged on postoperative day(POD)9.Case 2:A 55-year-old man was admitted for upper abdominal distension with pain and discomfort after eating for 3 mo.He was diagnosed with GC(cT3N1M0)with SIT.He had a history of hypertension for more than 10 years;however,his blood pressure was well-controlled via regular medication.We performed laparoscopy-assisted total gastrectomy with D2 LND and Roux-en-Y reconstruction.The operation was performed successfully within 168 min with an estimated blood loss of 50 mL and no severe complications.The patient was discharged on POD 10.CONCLUSION LAG with D2 LND could be considered an accessible,safe,and curative procedure for advanced GC patients with SIT.
文摘BACKGROUND Congenital tuberculosis(TB),tuberculous meningitis,and situs inversus totalis are rare diseases.We here report a patient who simultaneously suffered from these three rare diseases.There is currently no such report in the literature.Congenital TB is easily misdiagnosed and has a high case fatality rate.Timely anti-TB treatment is required.CASE SUMMARY A 19-day-old male newborn was admitted to hospital due to a fever for 6 h.His blood tests and chest X-rays suggested infection,and he was initially considered to have neonatal pneumonia and sepsis.He did not respond to conventional antiinfective treatment.Finally,Mycobacterium tuberculosis was found in sputum lavage fluid on the 10th day after admission.In addition,the mother's tuberculin skin test was positive,with an induration of 22 mm,and her pelvic computed tomography scan suggested the possibility of tuberculous pelvic inflammatory disease.The child was diagnosed with congenital TB and immediately managed with anti-TB therapy and symptomatic supportive treatment.However,the infant's condition gradually worsened and he developed severe tuberculous pneumonia and tuberculous meningitis,and eventually died of respiratory failure.CONCLUSION If conventional anti-infective treatment is ineffective in neonatal pneumonia,anti-TB treatment should be considered.
基金Supported by Chongqing medical scientific research project(Joint project of Chongqing Health Commission and Science and Technology Bureau),No.2021MSXM309.
文摘BACKGROUND Situs inversus totalis(SIT)is a rare group of congenital developmental malformations in the clinical setting,with all organs in the chest and abdomen existing in a mirror image reversal of their normal positions.Few reports have described laparoscopic surgery for colorectal cancer in patients with SIT,and it is considered difficult even for an experienced surgeon because of the mirror positioning.We present a case report of laparoscopic radical resection of a colonic splenic flexure carcinoma in a patient with SIT.CASE SUMMARY A 72-year-old male was referred to our hospital with colonic splenic flexure carcinoma,and computed tomography showed that all the organs in the chest and abdomen were inverted.Laparoscopic hemicolectomy with complete mesocolic excision was safely performed.The operating surgeon stood on the patient’s left side,which is opposite of the normal location.CONCLUSION Abdominal computed tomography is an effective method for diagnosing SIT preoperatively in patients with colonic splenic flexure carcinomas.Laparoscopic radical resection is difficult,but it is well established and safe.The surgeon should stand in the opposite position and perform backhand operations.
文摘Hepatocellular carcinoma(HCC)is the most commonly diagnosed carcinoma and one of the leading causes of cancer-related deaths worldwide.Situs inversus totalis(SIT)is a congenital condition where in the internal organs of the abdomen and thorax lie in mirror images of their normal position.Thus far,there are very few reports on cases of SIT coexisting with HCC.Our case series is probably the largest series in world literature.The cohort of this retrospective study included a total of nine patients diagnosed with SIT-HCC and treated in our hospital between January 2013 and May 2018.Clinical characteristics,prognostic factors,and outcomes were summarized.Treatment strategies included surgery,transarterial chemoembolization,and microwave ablation.The diagnosis and treatment of patients with SIT are challenging because of organ reversion.The current treatment strategies for different stages of liver cancer are safe and feasible for patients with SIT-HCC.
基金Supported by Chinese Ministry of Education(No.2020-39)Zunyi Science and Technology Project,No.Zunshi Kehe HZ(2020)246.
文摘BACKGROUND Single atrium with single ventricle,or a two-chambered heart,is an extremely rare congenital malformation.Few cases with two-chambered heart surviving to adulthood have been reported.CASE SUMMARY We reported an adult female patient with a two-chambered heart and situs inversus totalis accompanied by multiple pregnancies and abortions.Magnetic resonance imaging detected a two-chambered heart.B-ultrasound-guided uterine aspiration was performed to absorb 8 g and 10 g of organized villus and decidual tissues,respectively,with a small amount of bleeding.Postoperatively,cyanosis and fatigue-induced shortness of breath were gradually relieved.The patient has currently outlived all similar cases reported so far.CONCLUSION Hemodynamic changes in pregnant women with two-chambered heart impaired cardiac function,responsible for hypoperfusion and miscarriage.
文摘This recipient with situs inversus totalis(SIT) was a 60-year-old female who had hepatitis B-related endstage liver disease.Preoperative donor evaluation showed that the right posterior section satisfied graft volume and was space-fitting in the recipient hepatic fossa when it was rotated 180 degrees.The operation and postoperative course progressed satisfactorily.Three weeks after living donor liver transplantation(LDLT),the graft function was disturbed by compression of bottom-placed right hepatic vein.This was treated with a vascular stent and subsequently the graft function was normalized.The present case shows that LDLT for patients with SIT using a right posterior section graft is feasible.
文摘A 26-year-old patient with mirror-image dextrocardia and situs inversus experienced a transient ischemic attack.We suspected that a patent foramen ovale was the reason.A Cardi-O-Fix occluder was used to close the patent foramen ovale with a mirror-reversed rotation of the radiologic views.During the 18-month follow-up,no symptoms of the transient ischemic attack appeared again.
文摘Correction to"Laparoscopy-assisted resection of colorectal cancer with situs inversus totalis:A case report and literature review"World J Gastrointest Endosc 2020;12:310-316.In this article,we have replaced the previous TNM stage of colorectal cancer(T4aN0M0)and the revised TNM stage is provided(T4a-N1cM1c).
文摘<b>Introduction:</b> Left-sided acute appendicitis (LSAA) develops in association with two types of congenital anomalies: situs inversus totalis (SIT) and midgut malrotation (MM). A Left sided appendicitis is an ambiguous and difficult diagnosis to make. <b>Aim: </b>To present a proven case of left-sided acute appendicitis (LSAA) associated with situs inversus totalis (SIT). <b>Case</b> <b>Report:</b> A case of Left appendicitis was evaluated in a 28-year-old Asian male, who presented to our hospital in Feb. 2016, with lower abdominal pain more on left side and suspected diverticulitis or acute appendicitis with unusual appendix location. The patient doesn’t recall any history of abdominal surgery or about situs inversus totalis, abdominal and pelvic ultrasound was done, left iliac fossa appendicitis was diagnosed, Erect chest X-ray including upper abdomen revealed dextrocardia and stomach air on right side (situs inversus totalis), the patient underwent diagnostic Laproscop and Endoscopic resection of the appendix, with no incidents, and then discharged without complications, follow visits went unremarkable. <b>Conclusion: </b>The diagnosis of left lower quadrant pain is based on well-established clinical symptoms, physical examination and physician’s experience.
