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Sibs diagnosed prenatally with situs inversus totalis, renal and pancreatic dysplasia, and cysts: a new syndrome?

We describe two sib fetuses with situs inversus, cystic dysplastic kidney and pancreas, bowing of the lower limbs and clavicles, severe intrauterine growth retardation (IUGR), and oligohydramnios. Early prenatal diagnosis of pancreatic and dysplastic renal cysts and situs inversus totalis were made in the 18-week-old fetus. This syndrome differs from that of Ivemark and related syndromes because of the presence of situs inversus totalis and absence of hepatic fibrosis and cysts. The parents were first cousins, and did not have any cysts of kidney, liver, or pancreas detected by ultrasonography.

Abnormalities, Multiple↗

A case of hepatocellular carcinoma with situs inversus totalis.

We report a case of hepatocellular carcinoma with situs inversus totalis treated by hepatectomy. A 70-year-old asymptomatic female with hepatocellular carcinomas in segments 5, 6 and 8 underwent transarterial embolization in the department of medicine. However, hepatocellular carcinoma in segment 8 relapsed, and she was referred to the department of surgery. Laboratory tests revealed elevation of serum PIVKA2 level (4,690 ng/mL). Angiography revealed tumor stain in segment 8, 3 cm in diameter. No aberrant vessels were detected on angiography. The operator stood on the patient's left, and partial hepatectomy could be performed safety after careful examination of the anatomy. Although aberrant vessels are detected in many patients with situs inversus totalis, operations can be performed safely on them with sufficient understanding of the anatomy.

Aged↗

Situs inversus totalis with accompanying craniodiaphysial dysplasia: a new syndrome?

A 20-year-old man with craniofacial anomalies of craniodiaphysial dysplasia (CDD), facial paralysis, mental retardation, and situs inversus totalis is described. Similar features except situs inversus totalis are also present in two of his sisters. The authors believe this to be the first reported case of CDD with accompanying situs inversus totalis.

Adolescent↗

Atrioventricular discordance in situs inversus.

We retrospectively analysed the records of 23 patients with atrioventricular discordance in situs inversus and compared them with 121 cases of atrioventricular discordance in situs solitus seen during preceding four years. One hundred and two (70.8%) patients were male. The mean age was 9.3 +/- 10.1 years (range 1 day-48 years). Overall, a ventricular septal defect with pulmonic stenosis (Fallot's physiology) was seen in 76 (56.7%) cases, ventricular septal defect without pulmonic stenosis in 26 (18.1%) cases, atrioventricular valve regurgitation in 25 (17.3%) cases and complete heart block in 13 (9%) cases. Double outlet right ventricle and Fallot's physiology were significantly more common (74.0% vs 32.3% and 91.3% vs 45.0%, respectively; p < 0.005), whereas atrioventricular valve regurgitation and complete heart block were less common (4.3% vs 19.8% and 0% vs 10.7%, respectively; p < 0.05) in patients with situs inversus and atrioventricular discordance as compared to patients with situs solitus. These differences may influence the natural history and treatment options selected for patients with atrioventricular discordance.

Adolescent↗

Laparoscopic cholecystectomy in a 39-year-old female with situs inversus.

Kartagener syndrome consists of situs inversus, chronic sinusitis, and bronchiectasis. A 39-year-old woman known to have Kartagener syndrome presented with complaints of left upper abdominal quadrant pain. Suspicion of cholelithiasis was confirmed with ultrasound and oral cholecystogram. The patient underwent a laparoscopic cholecystectomy. Standard techniques were modified in mirror image fashion to provide access to the left upper quadrant. This unusual presentation of chronic calculus cholecystitis in a patient with Kartagener syndrome demonstrates the adaptability of laparoscopic cholecystectomy technique.

Adult↗

Laparoscopic cholecystectomy in situs inversus totalis.

A 51-year-old woman with known dextrocardia presented with left-sided abdominal pain and symptoms consistent with biliary colic and cholelithiasis. Abdominal ultrasound confirmed the diagnosis of gallstones, as well as situs inversus with the liver and gallbladder on the left side and the spleen on the right. Laparoscopic cholecystectomy was performed without incident. The procedure was uncomplicated except for being the mirror image of that done with the gallbladder in the normal location. Cholelithiasis occurring with situs inversus is rare and may present a diagnostic problem. The extrahepatic anatomy of the biliary and venous system is the mirror image of the right sided liver. Historic and genetic aspects of situs inversus, as well as current theories regarding its etiology are presented. Situs inversus totalis does not appear to be a contraindication to laparoscopic treatment of cholelithiasis.

Cholecystectomy↗

Situs inversus totalis and single coronary ostium: A coincidence or a pattern?

Situs inversus totalis and single coronary ostium are rare congenital anomalies, and no ontogenic connection has been described between them. Only three cases of association of single coronary ostium and situs inversus have been reported in the literature, all found on angiography. Here we present the first case of this association discovered at autopsy. Based on the apparently higher than expected frequency of this finding, an underlying pathologic connection between these conditions is proposed.

Adult↗

Situs inversus and myocardial revascularization. Case report.

This report describes an internal mammary artery by-pass grafting to the anterior descending coronary artery in a man with an unstable postinfarction angor pectoris and a "situs inversus totalis" condition. The association of "situs inversus totalis" and atherosclerotic coronary artery disease has the same incidence as in normal people. To the authors' knowledge, this is the second case in medical literature of coronary artery by-pass surgery with internal mammary artery graft in a patient with "situs inversus totalis".

Adult↗

Laparoscopic Roux-en-Y gastric bypass in a patient with situs inversus.

We report the case of a morbidly obese patient with situs inversus totalis presenting for laparoscopic Roux-en-Y gastric bypass (RYGBP). The operative technique is detailed and we recommend the use of a mirror image approach to all parts of the operation. Consequently, the operative time is only moderately longer than usual. Laparoscopic RYGBP can be safely performed in patients with situs inversus.

Comorbidity↗

Laparoscopic cholecystectomy in a patient with empyema of the gallbladder and situs inversus.

The successful performance of laparoscopic cholecystectomy in a patient with situs inversus viscerum and empyema of the gallbladder is reported. The 62-year-old man presented with pain in the left upper quadrant associated with fever, chills, nausea and vomiting. The abdomen was tender with guarding and a palpable globular mass in the same region. CT scan demonstrated a distended gallbladder with thick shaggy walls which contained a 2 cm gallstone in the neck and also revealed dextrocardia and situs inversus. The patient's postoperative recovery was uneventful.

Cholecystectomy, Laparoscopic↗

[Situs inversus and long-term bronchopneumopathies, existing since the neonatal period].

Four boys are described who developed respiratory difficulties and broncho-pulmonary disease in the neonatal period. Three had situs inversus, and one situs ambiguus (Ivemark's syndrome). The symptoms continued for several months or years and in three children progressed to bronchiectasis. The other child is recovered. Two the children were brothers and a third sib. presented with bronchopulmonary disease at birth that continued for 17 months. He did not have situs inversus.

Bronchial Diseases↗

Duplication/deficiency mapping of situs inversus viscerum (iv), a gene that determines left-right asymmetry in the mouse.

A recessive mutation in the mouse, situs inversus viscerum (iv), results in randomization of organ position along the left-right body axis: approximately 50% of the progeny of homozygous matings exhibit situs solitus and 50% exhibit situs inversus. Recent studies have established genetic linkage between iv and the immunoglobulin heavy chain gene complex (Igh-C), located on distal mouse chromosome 12. In the present study, we have refined the genetic map location of iv relative to the breakpoint of a reciprocal translocation, T(5;12)31H, involving the telomeric region of chromosome 12 distal to Igh-C and the proximal region of chromosome 5. The translocation results in a large 12(5) derivative chromosome and a small 5(12) derivative chromosome. Because mice with either monosomy or tertiary trisomy for the 5(12) chromosomal region are viable, duplication/deficiency mapping is possible. Deficiency mapping was performed by mating iv/iv homozygotes and T31H heterozygotes. Two animals monosomic for distal mouse chromosome 12 were produced. One of the animals with cytogenetically confirmed monosomy for distal chromosome 12 exhibited situs inversus, indicating that the iv mutation is located at or distal to the T31H breakpoint. For duplication analysis, matings were initially carried out between iv/iv homozygotes and unbalanced T31H animals trisomic for distal chromosome 12. Cytogenetically verified tertiary trisomic progeny were identified and backcrossed with iv/iv homozygotes. The resulting trisomic progeny, 50% of which are expected to carry the iv mutation on both cytogenetically normal copies of chromosome 12, were scored for phenotype.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

[Cor triatriatum with situs inversus totalis: a case report of an infant].

Cor triatriatum associated with situs inversus is rare. A 6-month-old male who had cor triatriatum with atrial septal defect (ASD) and situs inversus totalis was successfully operated. Urgent surgical intervention was performed because of congestive cardiac failure despite drug therapy. The abnormal septum in the left atrium was resected and ASD was closed. His postoperative course has been uneventful.

Cardiac Catheterization↗

Mutations in the DNAH11 (axonemal heavy chain dynein type 11) gene cause one form of situs inversus totalis and most likely primary ciliary dyskinesia.

Primary ciliary dyskinesia (PCD; MIM 242650) is an autosomal recessive disorder of ciliary dysfunction with extensive genetic heterogeneity. PCD is characterized by bronchiectasis and upper respiratory tract infections, and half of the patients with PCD have situs inversus (Kartagener syndrome). We characterized the transcript and the genomic organization of the axonemal heavy chain dynein type 11 (DNAH11) gene, the human homologue of murine Dnah11 or lrd, which is mutated in the iv/iv mouse model with situs inversus. To assess the role of DNAH11, which maps on chromosome 7p21, we searched for mutations in the 82 exons of this gene in a patient with situs inversus totalis, and probable Kartagener syndrome associated with paternal uniparental disomy of chromosome 7 (patUPD7). We identified a homozygous nonsense mutation (R2852X) in the DNAH11 gene. This patient is remarkable because he is also homozygous for the F508del allele of the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Sequence analysis of the DNAH11 gene in an additional 6 selected PCD sibships that shared DNAH11 alleles revealed polymorphic variants and an R3004Q substitution in a conserved position that might be pathogenic. We conclude that mutations in the coding region of DNAH11 account for situs inversus totalis and probably a minority of cases of PCD.

Axonemal Dyneins↗

ERCP and laparoscopic cholecystectomy for cholangitis in a 66-year-old male with situs inversus.

A case report of the successful management of a patient with situs inversus viscerum and symptomatic choledocholithiasis and cholangitis is presented. The preoperative evaluation of the choledochus via ERCP and successful common bile duct stone extraction enabled successful laparoscopic cholecystectomy. The anatomic challenge of situs inversus viscerum mandates the selective use of intraoperative cholangiography during and upon completion of the laparoscopic cholecystectomy.

Aged↗

[Pancreas head carcinoma associated with situs inversus viscerum totalis].

The patient was a seventy seven years old male whose chief complaint was jaundice. Chest and abdomen roentgenogram showed situs inversus viscerum totalis. Echographically, pancreas head tumor was showed. Stenosis of inferior bile duct and dilatation of main pancreatic duct were showed by percutaneous transhepatic cholangiography and endoscopic retrograde cholangio pancreaticography. So, pancreas head carcinoma associated with situs inversus viscerum totalis was diagnosed. Pancreaticoduodenectomy and modified Child method was undergone. At the time of operation, liver was recognized left side of abdomen. The tumor was diagnosed well or moderately differentiated papillotubular adenocarcinoma by pathological study. This unusual combination of situs inversus viscerum totalis and pancreas head carcinoma was reported.

Adenocarcinoma, Papillary↗

Ascending colon cancer with hepatic metastasis and cholecystolithiasis in a patient with situs inversus totalis without any expression of UVRAG mRNA: report of a case.

Situs inversus totalis refers to an inverted position of part or all of the viscera, which represents a mirror-image of the normal location, and it is a relatively rare condition that occurs in one in 4,000-8,000 people in Japan. We herein report a patient demonstrating a combination of situs inversus totalis, colon cancer with hepatic metastasis, and cholecystolithiasis, who was treated surgically. We found no expression of UVRAG mRNA in our case, thus suggesting that the UVRAG gene is partly responsible for this condition.

Aged↗