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Suspected appendicitis in situs inversus totalis: an indication for a laparoscopic approach.

We report a case of acute appendicitis in situs inversus treated by laparoscopy. In our opinion, diagnostic laparoscopy is indicated if acute appendicitis is suspected in a patient with situs inversus totalis, either because the pain can be referred to the right iliac fossa in about 50% of the patients, or because the incision in open surgery cannot be sufficient to allow complete exploration of the abdomen. The operation can then be carried out laparoscopically if possible; if not, an appropriate surgical incision can be made.

Acute Disease↗

Situs inversus totalis and congenital hypoglossia.

Hypoglossia is a rare congenital malformation, occurring either as an isolated malformation or in association with other deformities, particularly limb defects. We describe a female infant with congenital hypoglossia, micrognathia and situs inversus. The main complications were airway compromise and feeding difficulties requiring tracheostomy and gastrostomy. Situs inversus and hypoglossia have been reported together on six previous occasions, with all cases being sporadic. Situs inversus-hypoglossia falls into a spectrum of aetiologically non-specific developmental field defects that includes the Aglossia-adactylia spectrum and the Agnathia-holoprosencephaly spectrum. Situs inversus-hypoglossia may represent a mild form of Agnathia-holoprosencephaly.

Female↗

[Cerebral abscess disclosing tetralogy of Fallot with situs inversus in adulthood].

The authors report the case of tetralogy of Fallot (TOF) associated with situs inversus, the first description of this rare association in a previously asymptomatic adult. A 32 years old chauffeur was admitted to hospital with pyrexia and convulsions due to a left temporo-parietal cerebral abscess which had a favourable outcome. The chest X-ray and Doppler echocardiographic study showed a TOF with a high infundibular stenosis and dextrocardia. Abdominal ultrasonography confirmed a complete situs inversus. The good tolerance was attributed to the equilibrated character of the TOF. The orientation of the heart and the cono-truncal septation occur at different times during embryogenesis. However, there are genetic arguments in favour of the non-fortuitous nature of this association.

Adult↗

Handedness and situs inversus in primary ciliary dyskinesia.

... The limbs on the right side are stronger. [The] cause may be ... [that] ... motion, and abilities of moving, are somewhat holpen from the liver, which lieth on the right side. (Sir Francis Bacon, Sylva sylvarum (1627).)Fifty per cent of people with primary ciliary dyskinesia (PCD) (also known as immotile cilia syndrome or Siewert-Kartagener syndrome) have situs inversus, which is thought to result from absent nodal ciliary rotation and failure of normal symmetry breaking. In a study of 88 people with PCD, only 15.2% of 46 individuals with situs inversus, and 14.3% of 42 individuals with situs solitus, were left handed. Because cerebral lateralization is therefore still present, the nodal cilia cannot be the primary mechanism responsible for symmetry breaking in the vertebrate body. Intriguingly, one behavioural lateralization, wearing a wrist-watch on the right wrist, did correlate with situs inversus.

Functional Laterality↗

ERCP in situs inversus: do we need to turn the other way?

Endoscopic procedures are difficult in patients with situs inversus owing to left-right reversal of viscera. Conventionally, reversal of the position of the endoscopist in relation to the patient is advocated to overcome the anatomical difficulty. We describe a patient with chronic calcific pancreatitis and pseudocyst of the pancreas who had situs inversus. ERCP was performed with minor modification of maneuvers with the patient in the usual left lateral decubitus and the endoscopist on the left of the table.

Adult↗

Laparoscopic cholecystectomy in situs inversus totalis: a case report.

Some of the numerous anomalies of the biliary tract and its vasculature are incompatible with life, whereas others are only medical curiosities. Many, however, are the cause of symptoms, and all are of particular concern to the surgeon who must operate in this area. An example is situs inversus totalis, an anomaly of the biliary tract that can present difficulties in management of abdominal disorders. We present a case of transposition of the viscera (situs inversus) with cholelithiasis, treated successfully with laparoscopy cholecystectomy. This article further affirms the safety and efficacy of laparoscopy in the setting of situs inversus totalis after giving due attention to the details of left-right reversal.

Adult↗

Situs inversus abdominus and malrotation in an adult with Ladd's band formation leading to intestinal ischaemia.

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.

Adult↗

Perforated appendix in situs inversus viscerum. A case report.

A patient with situs inversus viscerum and a perforated left-sided appendix is reported. The embryological anomalies which result in a left-sided appendix are mentioned. Although the viscera are transposed, it is thought that the components of the nervous system which supply the affected organs are not reversed. Diagnostic difficulties are mentioned.

Adult↗

Structural and functional brain asymmetries in human situs inversus totalis.

OBJECTIVE: To determine whether individuals with situs inversus totalis (SI), a condition in which there is a mirror-image reversal of asymmetric visceral organs, have alterations in brain asymmetries. BACKGROUND: The human brain is asymmetric in structure and function. Although correlations between anatomic asymmetries and functional lateralization in human brain have been demonstrated, it has been difficult to further analyze them. Characterization of asymmetries of brain structure and function in SI might advance the understanding of these relationships. METHODS: Using anatomic and functional MRI techniques, we analyzed asymmetries in the brains of three individuals with SI. RESULTS: Two major anatomic asymmetries of the cerebral hemispheres, the frontal and occipital petalia, were reversed in individuals with SI. In contrast, SI subjects had left cerebral hemisphere language dominance on functional MRI analysis as well as strong right-handedness. CONCLUSION: These observations suggest that the developmental factors determining anatomic asymmetry of the cerebral petalia and viscera are distinct from those producing the functional lateralization of language.

Adult↗

Laparoscopic gastric banding for morbid obesity in a patient with situs inversus totalis.

We discuss the operative challenges posed by the advanced laparoscopic approach for a patient with situs inversus totalis. The patient was a morbidly obese woman with multiple co-morbidities related to her weight. The modifications in the surgical technique include the insertion of trocars according to the mirror image anatomy of the intra-abdominal organs under laparoscopic visualization. We suggest preoperative abdominal ultrasound in order to diagnose both gallbladder stones and also the reverse location of intra-abdominal organs that is rarely seen. A laparoscopic gastric banding, not a contradiction for situs inversus totalis, was performed successfully.

Adult↗

Accessory mitral valve tissue associated with situs inversus in an elderly patient.

We report an unusual case of accessory mitral valve tissue associated with a situs inversus and missing obstruction of the left ventricular outflow tract. To our knowledge our patient is the only elderly patient with an accessory mitral valve with associated situs inversus undergoing surgical resection. The report emphasizes direct cardioscopy through the aortic annulus allowing precise excision of the abnormal tissue.

Echocardiography, Transesophageal↗

Dextrocardia, situs inversus and severe mitral stenosis in a pregnant woman: successful closed commissurotomy.

A 16-weeks' pregnant woman with situs inversus and dextrocardia underwent successful closed commissurotomy for severe mitral stenosis. The electrocardiogram revealed sinus rhythm with right axis deviation and progressive diminishing of QRS amplitude towards the left precordial leads. The chest X-ray showed dextrocardia with situs inversus. Doppler echocardiography depicted severe mitral stenosis; the mitral valve area increased from 0.9 cm2 pre-operatively to 1.8 cm2 post-operatively with mild increase of mitral regurgitation from grade I to II post-valvotomy. She also had associated mild functional tricuspid insufficiency and moderate pulmonary hypertension. No thrombo-embolic complications occurred intra- or post-operatively. There was no evidence of either clinical or Doppler restenosis. The course of pregnancy was uneventful. At 39 weeks a healthy baby was vaginally delivered. The patient is still free of cardiac symptoms.

Adult↗

Situs inversus and bowel malrotation: contribution of prenatal diagnosis and laparoscopy.

The authors report 3 different cases of prenatal diagnosis of situs inversus associated with bowel malrotation. Heterotaxy existed in 2 cardiosplenic syndromes (1 left and 1 right isomerism), and 1 isolated situs inversus. Bowel malrotation was detected at birth by ultrasonography and intestinal contrast study. Patients underwent laparoscopic LADD's procedure and abdominal exploration in the neonatal period. The authors advocate neonatal screening and early surgical management of bowel malrotation in prenatally diagnosed heterotaxic syndromes.

Adult↗

Conserved left-right asymmetry of nodal expression and alterations in murine situs inversus.

Vertebrates have characteristic and conserved left-right (L-R) visceral asymmetries, for example the left-sided heart. In humans, alterations of L-R development can have serious clinical implications, including cardiac defects. Although little is known about how the embryonic L-R axis is established, a recent study in the chick embryo revealed L-R asymmetric expression of several previously cloned genes, including Cnr-1 (for chicken nodal-related-1), and indicated how this L-R molecular asymmetry might be important for subsequent visceral morphogenesis. Here we show that nodal is asymmetrically expressed in mice at similar stages, as is Xnr-1 (for Xenopus nodal related-1) in frogs. We also examine nodal expression in two mouse mutations that perturb L-R development, namely situs inversus viscerum (iv), in which assignment of L-R asymmetry is apparently random and individuals develop either normally or are mirror-image-reversed (situs inversus), and inversion of embryonic turning (inv), in which all individuals develop with situs inversus. In both, nodal expression is strikingly affected, being reversed or converted to symmetry. These results further support a key role for nodal and nodal-related genes in interpreting and relaying L-R patterning information in vertebrates. To our knowledge, our results provide the first direct evidence that iv and inv normally function well before the appearance of morphological L-R asymmetry.

Animals↗

Stanford type A acute aortic dissection caused by blunt trauma in a patient with situs inversus.

We report a case of Stanford type A acute aortic dissection caused by blunt trauma in a patient with situs inversus. A 57-year-old man was involved in an explosion accident. It was indicated that he had suffered Stanford type A acute aortic dissection, cardiac tamponade, and situs inversus by contrast enhanced computed tomography and echocardiography. With the introduction of anesthesia, he went into shock. An extracorporeal circuit was immediately introduced with heart massage. The ascending aorta was replaced with a prosthesis using cardiopulmonary bypass. The branches of the aortic arch were mirror-image reversed. The patient's general condition improved, and he was discharged from our department 3 weeks after the operation.

Aortic Dissection↗

[Complete situs inversus in one half of a monozygotic twin].

The history of a monochorial monoamniotic twin, born at 27 weeks of gestation, in which a situs inversus was present in one of the twin is given. The incidence of a situs inversus in twins and the etiologic factors as described in literature are given.

Autopsy↗