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
AIM:To give an overview of the literature on left-sided acute appendicitis (LSAA) associated with situs inversus totalis (SIT) and midgut malrotation (MM).METHODS:We present a new case of LSAA with SIT and a literatur...AIM:To give an overview of the literature on left-sided acute appendicitis (LSAA) associated with situs inversus totalis (SIT) and midgut malrotation (MM).METHODS:We present a new case of LSAA with SIT and a literature review of studies published in the English language on LSAA,accessed via PubMed and Google Scholar databases.RESULTS:Ninety-five published cases of LSAA were evaluated and a 25-year-old female,who presented to our clinic with left lower abdominal pain caused by LSAA,is reported.In the reviewed literature,fiftyseven patients were male and 38 were female with an age range of 8 to 82 years and a median age of 29.1 ± 15.9 years.Sixty-six patients had SIT,23 had MM,three had cecal malrotation,and two had a previously unnoted congenital abnormality.Fifty-nine patients had presentedto the hospital with left lower,14 with right lower and seven with bilateral lower quadrant pain,and seven subjects complained of left upper quadrant pain.The diagnosis was established preoperatively in 49 patients,intraoperatively in 19,and during the postoperative period in five;14 patients were aware of having this anomaly.The data of eight patients were not unavailable.Eleven patients underwent laparoscopic appendectomy,which was combined with cholecystectomy in two cases.Histopathological examination of the appendix specimens revealed adenocarcinoma in only two of 95 patients.CONCLUSION:The diagnosis of left lower quadrant pain is based on well-established clinical symptoms,physical examination and physician's experience.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
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
Cholecystectomy is a common procedure.Abnormalities in the anatomy of the biliary system are common but an abnormal location of the gallbladder is much rarer.Despite frequent pre-operative imaging,the aberrant locatio...Cholecystectomy is a common procedure.Abnormalities in the anatomy of the biliary system are common but an abnormal location of the gallbladder is much rarer.Despite frequent pre-operative imaging,the aberrant location of the gallbladder is commonly discovered at surgery.This article presents a case of a patient with the gallbladder located to the left of the falciform ligament in the absence of situs inversus totalis that presented with right upper quadrant pain.A laparoscopic cholecystectomy was performed and it was noted that the cystic duct originated from the right side.The presence of a left sided gall bladder is often associated with various biliary,portal venous and other anomalies that might lead to intra-operative injuries.The spectrum of unusual positions and anatomical gallbladder abnormalities is reviewed in order to facilitate elective and emergent cholecystectomy as well as other hepatobiliary procedures.With proper identification of the anatomy,minimally invasive approaches are still considered safe.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
Situs inversus totalis （SIT） is a rare congenital abnormality that affects approximately 0.005% of all live births. 1 Liver grafts with SIT have traditionally been considered as an absolute contraindication for tra...Situs inversus totalis （SIT） is a rare congenital abnormality that affects approximately 0.005% of all live births. 1 Liver grafts with SIT have traditionally been considered as an absolute contraindication for transplant because of anatomical concerns.2 A review of the literature indicated that there were only four cases of liver transplantation using an SIT donor and normal recipient.3-6 Various modified ＂piggyback＂ techniques were used in all of these cases. In the present case, we obtained a liver from a deceased donor with SIT,展开更多
Situs inversus viscerum(SIV)is a rare congenitalcondition characterized by complete transposition of all viscera.This anatomical pathology makes endoscopic retrograde cholangiopancreatography(ERCP)technically difficul...Situs inversus viscerum(SIV)is a rare congenitalcondition characterized by complete transposition of all viscera.This anatomical pathology makes endoscopic retrograde cholangiopancreatography(ERCP)technically difficult.We report a new case of a 70-year-old Chinese male with total SIV who had obstructive jaundice.Magneticresonance cholangiopancreatography demonstrated a number of stones in the gallbladder and common bile duct(CBD).Therapeutic ERCP was performed to relieve biliary obstruction and remove the CBD stones.This procedure started with the patient in a supine position and the endoscopist at the left side of the table.When the papilla was maintained,the patient was repositioned to a prone position and standard endoscopic sphincterotomy and endoscopic papillary balloon dilatation procedures were conducted.ERCP was performed successfully and relevant complications did not occur in this patient.We also present a review of the literature published between 1985 and 2014in the Pub Med and EMBASE databases.There were eight published cases during this period,with one each from America,Finland,India,Italy,South Korea and Pakistan,and two from Spain.Our case is the first reported in China.展开更多
BACKGROUND Situs inversus totalis(SIT)is a rare congenital condition that is characterized by a complete mirror image of the typical arrangement of the thoracic and abdominal viscera.Performing thoracoscopic segmentec...BACKGROUND Situs inversus totalis(SIT)is a rare congenital condition that is characterized by a complete mirror image of the typical arrangement of the thoracic and abdominal viscera.Performing thoracoscopic segmentectomy for a patient with lung cancer and SIT is an extremely skilled and challenging surgical procedure.CASE SUMMARY A 41-year old woman with a medical history of dextrocardia since childhood was admitted to our hospital with a mixed ground-glass opacity(mGGO)in her left lung field,discovered by computed tomography during her health checkup.In order to facilitate surgical orientation,three-dimensional computed tomography bronchography and angiography(3D-CTBA)was preoperatively carried out.The result of 3D-CTBA was consistent with the diagnosis of SIT and an mGGO in the posterior segment of the left upper lobe(LS2).Surgery was conducted in accordance with preoperative 3D-CTBA and designed surgical procedure,combined with intraoperative navigation.Final pathological examination revealed in situ adenocarcinoma.The patient’s postoperative condition was uneventful and no complications were observed.CONCLUSION We present the first case of lung cancer in a patient with SIT who successfully underwent thoracoscopic segmentectomy assisted by 3D-CTBA.This is a new technique that covers precise confirmation and dissection of targeted structures and intersegmental demarcation,and can help achieve a meticulous anatomical segmentectomy.展开更多
BACKGROUND Hypoparathyroidism(HP)is a rare endocrine disorder,while situs inversus totalis(SIT)is a rare condition in which the internal organs are positioned in a mirrored pattern compared to their usual positions.Th...BACKGROUND Hypoparathyroidism(HP)is a rare endocrine disorder,while situs inversus totalis(SIT)is a rare condition in which the internal organs are positioned in a mirrored pattern compared to their usual positions.This case illustrates some potential shared mechanisms between HP and SIT,highlighting the importance of accurate identification and prompt first emergency,offering insights for future research.CASE SUMMARY This report discusses a case of a middle-aged patient with adolescent-onset HP with concurrent SIT.The patient experienced recurrent episodes of increased neuromuscular excitability(manifesting as spasms in the hands and feet and laryngospasms)and even periods of unconsciousness.Initially,these symptoms led to a misdiagnosis of epilepsy.Nevertheless,upon thorough examination and treatment in the general medicine ward,the correct diagnosis was established.Corresponding treatment resulted in improved management of the patient’s symptoms.CONCLUSION Co-occurrence of HP and SIT may be associated with genetic mutations,chromosomal anomalies,or hereditary factors,as may other similar conditions.展开更多
SITUS inversus totalis （SIT） is a complete mirrorimage of the thoracic and abdominal viscera,occurring at an incidence of 1 in 5000-20 000live births.1, 2 It is supposed to originate from anabnormal rotation of the ...SITUS inversus totalis （SIT） is a complete mirrorimage of the thoracic and abdominal viscera,occurring at an incidence of 1 in 5000-20 000live births.1, 2 It is supposed to originate from anabnormal rotation of the cardiac tube during embryogenesis.Although SIT is a congenital anomaly, most of patients aredetected accidentally at the time of radiological investigation.Hepatocellular carcinoma （HCC） is usually associated withliver cirrhosis and portal hypertension in Chinese. Presenceof hypersplenic thrombocytopenia is a common consequenceof long-term portal hypertension in cirrhoticpatients.展开更多
Situs inversus totalis(SIT) is a rare anomaly in which the abdominal and thoracic cavity structures are located opposite to their usual positions. Occasionally,patients with this condition are diagnosed with malignant...Situs inversus totalis(SIT) is a rare anomaly in which the abdominal and thoracic cavity structures are located opposite to their usual positions. Occasionally,patients with this condition are diagnosed with malignant tumors. We report a case of a 60-yearold woman with gastric cancer and SIT. Laparoscopyassisted distal gastrectomy(LADG) with D2 lymph node dissection and Billroth Ⅱ anastomosis were performed successfully on the patient by careful consideration of the mirror-image anatomy. The operation required 230 min, and no intraoperative complications occurred. The final pathological report was p T4 a N0M0,according to the American Joint Committee on Cancer 7th edition staging guidelines. The postoperative course was favorable, and the patient was discharged on postoperative day 8. We believe that this is the first case of LADG with D2 lymphadenectomy reported in a SIT patient with advanced gastric cancer.展开更多
Situs inversus （SI） is a congenital anomaly characterized by the mirror-image orientation of the inner organs. The estimated incidence of SI is 1/15 000 to 1/10 000 live births. The disease is often complicated with...Situs inversus （SI） is a congenital anomaly characterized by the mirror-image orientation of the inner organs. The estimated incidence of SI is 1/15 000 to 1/10 000 live births. The disease is often complicated with biliary atresia, polysplenia, intestinal nonrotation, preduodenal portal vein, aberrant hepatic artery, or absence of the suprarenal inferior vena cava. In 2004, we performed a liver transplantation on a patient with SI complicated with hepatolithiasis, end-stage liver cirrhosis and liver failure, because of the unavailability of donor organs, the operation became more complicated and difficult.展开更多
The aim of this case report is to raise awareness about the use of 3-Dimentional Computed Tomography (3D-CT) virtual reality imaging as a routine pre-operative tool for evaluation of unusual anatomy such as Situs Inve...The aim of this case report is to raise awareness about the use of 3-Dimentional Computed Tomography (3D-CT) virtual reality imaging as a routine pre-operative tool for evaluation of unusual anatomy such as Situs Inversus Totalis (SIT). We present a case of presumed lung cancer in a 58 years old lady with SIT successfully treated by VATS lobectomy via an anterior approach. She presented with an incidental solitary pulmonary nodule in her right lower lobe, which had moderate FDG uptake on the PET scan. The nodule was too deep to permit safe wedge biopsy, due to proximity of a large pulmonary arterial branch. 3D-CT images were invaluable in pre-operative assessment of the anatomy and were the key to safe completion of right VATS lower lobectomy. Sectioning the lung after retrieval of the specimen suggested a chondroid hamartoma;therefore, systemic nodal dissection (SND) was not contemplated. The final histology confirmed the diagnosis of chondroid hamartoma. In an unusual anatomy such as SIT, 3D-CT allows construction of virtual reality models that can be viewed and manipulated before and during the operation to understand the anatomy better, highlight caveats around target structures and enable localisation of lesions unlikely to be palpated intra-operatively.展开更多
Situs inversus totalis(SIT) is a rare anomaly in which the abdominal and thoracic cavity structures are opposite their usual positions.Occasionally,a few patients with a combination of this condition and malignant tu... Situs inversus totalis(SIT) is a rare anomaly in which the abdominal and thoracic cavity structures are opposite their usual positions.Occasionally,a few patients with a combination of this condition and malignant tumors have been encountered.Recently,several laparoscopic operations have been reported in patients with SIT.We report a case of an 83-year-old man with situs inversus totalis who developed colon cancer after open distal gastrectomy.Laparoscopic hemicolectomy with radical lymphadenectomy in such a patient was successfully performed by careful consideration of the mirror-image anatomy.Techniques themselves was not different from those in ordinary cases.Thus,curative laparoscopic surgery for colon cancer in the presence of situs inversus totalis is feasible and safe.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
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
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
AIM: To discover the molecular pathogenic basis of the blepharophimosis, ptosis, and epicanthus inversus syndrome(BPES), and to predict the clinical subtype according to in vitro experiments, which is significant to t...AIM: To discover the molecular pathogenic basis of the blepharophimosis, ptosis, and epicanthus inversus syndrome(BPES), and to predict the clinical subtype according to in vitro experiments, which is significant to the prognosis.METHODS: A 3-year-old sporadic female patient with typical clinical manifestations of BPES was enrolled. The coding region of forkhead box L2(FOXL2) gene was sequenced, and the functional assays were performed in vitro by Western blotting, subcellular localization experiment, luciferase reporter assay, and quantitative realtime polymerase chain reaction.RESULTS: A novel FOXL2 point pathogenic variant(c.274G>T) was detected, resulting in a truncated protein(p.E92*). Functional studies demonstrated that the FOXL2 pathogenic variant induced the subcellular mislocalization and the abnormal transcriptional activity on promoters of the steroidogenic acute regulatory protein(StAR or STARD1) gene and the odd-skipped related 2 transcription factor(OSR2) gene.CONCLUSION: A novel pathogenic variant is identified to expand the spectrum of the known FOXL2 mutations. The in vitro experiments provide reference data and more insights to the molecular pathogenesis of BPES. The predicted high risk of ovarian insufficiency makes it significant for the patient enrolled to have further follow-up and therapy concerning female endocrinology.展开更多
Situs inversus is a rare congenital anomaly referring to the mirror image of the abdominal and thoracic viscera. It can be discovered routinely or on the occasion of a complication related or not to situs inversus. We...Situs inversus is a rare congenital anomaly referring to the mirror image of the abdominal and thoracic viscera. It can be discovered routinely or on the occasion of a complication related or not to situs inversus. We report a case of Situs inversus discovered incidentally during surgery for acute intestinal obstruction caused by an iatrogenic uterine perforation.展开更多
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AIM:To give an overview of the literature on left-sided acute appendicitis (LSAA) associated with situs inversus totalis (SIT) and midgut malrotation (MM).METHODS:We present a new case of LSAA with SIT and a literature review of studies published in the English language on LSAA,accessed via PubMed and Google Scholar databases.RESULTS:Ninety-five published cases of LSAA were evaluated and a 25-year-old female,who presented to our clinic with left lower abdominal pain caused by LSAA,is reported.In the reviewed literature,fiftyseven patients were male and 38 were female with an age range of 8 to 82 years and a median age of 29.1 ± 15.9 years.Sixty-six patients had SIT,23 had MM,three had cecal malrotation,and two had a previously unnoted congenital abnormality.Fifty-nine patients had presentedto the hospital with left lower,14 with right lower and seven with bilateral lower quadrant pain,and seven subjects complained of left upper quadrant pain.The diagnosis was established preoperatively in 49 patients,intraoperatively in 19,and during the postoperative period in five;14 patients were aware of having this anomaly.The data of eight patients were not unavailable.Eleven patients underwent laparoscopic appendectomy,which was combined with cholecystectomy in two cases.Histopathological examination of the appendix specimens revealed adenocarcinoma in only two of 95 patients.CONCLUSION:The diagnosis of left lower quadrant pain is based on well-established clinical symptoms,physical examination and physician's experience.
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Cholecystectomy is a common procedure.Abnormalities in the anatomy of the biliary system are common but an abnormal location of the gallbladder is much rarer.Despite frequent pre-operative imaging,the aberrant location of the gallbladder is commonly discovered at surgery.This article presents a case of a patient with the gallbladder located to the left of the falciform ligament in the absence of situs inversus totalis that presented with right upper quadrant pain.A laparoscopic cholecystectomy was performed and it was noted that the cystic duct originated from the right side.The presence of a left sided gall bladder is often associated with various biliary,portal venous and other anomalies that might lead to intra-operative injuries.The spectrum of unusual positions and anatomical gallbladder abnormalities is reviewed in order to facilitate elective and emergent cholecystectomy as well as other hepatobiliary procedures.With proper identification of the anatomy,minimally invasive approaches are still considered safe.
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Situs inversus totalis （SIT） is a rare congenital abnormality that affects approximately 0.005% of all live births. 1 Liver grafts with SIT have traditionally been considered as an absolute contraindication for transplant because of anatomical concerns.2 A review of the literature indicated that there were only four cases of liver transplantation using an SIT donor and normal recipient.3-6 Various modified ＂piggyback＂ techniques were used in all of these cases. In the present case, we obtained a liver from a deceased donor with SIT,
文摘Situs inversus viscerum(SIV)is a rare congenitalcondition characterized by complete transposition of all viscera.This anatomical pathology makes endoscopic retrograde cholangiopancreatography(ERCP)technically difficult.We report a new case of a 70-year-old Chinese male with total SIV who had obstructive jaundice.Magneticresonance cholangiopancreatography demonstrated a number of stones in the gallbladder and common bile duct(CBD).Therapeutic ERCP was performed to relieve biliary obstruction and remove the CBD stones.This procedure started with the patient in a supine position and the endoscopist at the left side of the table.When the papilla was maintained,the patient was repositioned to a prone position and standard endoscopic sphincterotomy and endoscopic papillary balloon dilatation procedures were conducted.ERCP was performed successfully and relevant complications did not occur in this patient.We also present a review of the literature published between 1985 and 2014in the Pub Med and EMBASE databases.There were eight published cases during this period,with one each from America,Finland,India,Italy,South Korea and Pakistan,and two from Spain.Our case is the first reported in China.
基金Supported by The National Natural Science Foundation of China,No.81800050Natural Science Fund of Yangzhou City,No.YZ2017119Science and Technology Innovation Cultivation Program of Yangzhou University,No.2017CXJ122
文摘BACKGROUND Situs inversus totalis(SIT)is a rare congenital condition that is characterized by a complete mirror image of the typical arrangement of the thoracic and abdominal viscera.Performing thoracoscopic segmentectomy for a patient with lung cancer and SIT is an extremely skilled and challenging surgical procedure.CASE SUMMARY A 41-year old woman with a medical history of dextrocardia since childhood was admitted to our hospital with a mixed ground-glass opacity(mGGO)in her left lung field,discovered by computed tomography during her health checkup.In order to facilitate surgical orientation,three-dimensional computed tomography bronchography and angiography(3D-CTBA)was preoperatively carried out.The result of 3D-CTBA was consistent with the diagnosis of SIT and an mGGO in the posterior segment of the left upper lobe(LS2).Surgery was conducted in accordance with preoperative 3D-CTBA and designed surgical procedure,combined with intraoperative navigation.Final pathological examination revealed in situ adenocarcinoma.The patient’s postoperative condition was uneventful and no complications were observed.CONCLUSION We present the first case of lung cancer in a patient with SIT who successfully underwent thoracoscopic segmentectomy assisted by 3D-CTBA.This is a new technique that covers precise confirmation and dissection of targeted structures and intersegmental demarcation,and can help achieve a meticulous anatomical segmentectomy.
基金Supported by Zunyi Science and Technology Plan Program No.HZ(2022)48Zunyi Science and Technology Plan Program,No.HZ(2023)60.
文摘BACKGROUND Hypoparathyroidism(HP)is a rare endocrine disorder,while situs inversus totalis(SIT)is a rare condition in which the internal organs are positioned in a mirrored pattern compared to their usual positions.This case illustrates some potential shared mechanisms between HP and SIT,highlighting the importance of accurate identification and prompt first emergency,offering insights for future research.CASE SUMMARY This report discusses a case of a middle-aged patient with adolescent-onset HP with concurrent SIT.The patient experienced recurrent episodes of increased neuromuscular excitability(manifesting as spasms in the hands and feet and laryngospasms)and even periods of unconsciousness.Initially,these symptoms led to a misdiagnosis of epilepsy.Nevertheless,upon thorough examination and treatment in the general medicine ward,the correct diagnosis was established.Corresponding treatment resulted in improved management of the patient’s symptoms.CONCLUSION Co-occurrence of HP and SIT may be associated with genetic mutations,chromosomal anomalies,or hereditary factors,as may other similar conditions.
文摘SITUS inversus totalis （SIT） is a complete mirrorimage of the thoracic and abdominal viscera,occurring at an incidence of 1 in 5000-20 000live births.1, 2 It is supposed to originate from anabnormal rotation of the cardiac tube during embryogenesis.Although SIT is a congenital anomaly, most of patients aredetected accidentally at the time of radiological investigation.Hepatocellular carcinoma （HCC） is usually associated withliver cirrhosis and portal hypertension in Chinese. Presenceof hypersplenic thrombocytopenia is a common consequenceof long-term portal hypertension in cirrhoticpatients.
文摘Situs inversus totalis(SIT) is a rare anomaly in which the abdominal and thoracic cavity structures are located opposite to their usual positions. Occasionally,patients with this condition are diagnosed with malignant tumors. We report a case of a 60-yearold woman with gastric cancer and SIT. Laparoscopyassisted distal gastrectomy(LADG) with D2 lymph node dissection and Billroth Ⅱ anastomosis were performed successfully on the patient by careful consideration of the mirror-image anatomy. The operation required 230 min, and no intraoperative complications occurred. The final pathological report was p T4 a N0M0,according to the American Joint Committee on Cancer 7th edition staging guidelines. The postoperative course was favorable, and the patient was discharged on postoperative day 8. We believe that this is the first case of LADG with D2 lymphadenectomy reported in a SIT patient with advanced gastric cancer.
文摘Situs inversus （SI） is a congenital anomaly characterized by the mirror-image orientation of the inner organs. The estimated incidence of SI is 1/15 000 to 1/10 000 live births. The disease is often complicated with biliary atresia, polysplenia, intestinal nonrotation, preduodenal portal vein, aberrant hepatic artery, or absence of the suprarenal inferior vena cava. In 2004, we performed a liver transplantation on a patient with SI complicated with hepatolithiasis, end-stage liver cirrhosis and liver failure, because of the unavailability of donor organs, the operation became more complicated and difficult.
文摘The aim of this case report is to raise awareness about the use of 3-Dimentional Computed Tomography (3D-CT) virtual reality imaging as a routine pre-operative tool for evaluation of unusual anatomy such as Situs Inversus Totalis (SIT). We present a case of presumed lung cancer in a 58 years old lady with SIT successfully treated by VATS lobectomy via an anterior approach. She presented with an incidental solitary pulmonary nodule in her right lower lobe, which had moderate FDG uptake on the PET scan. The nodule was too deep to permit safe wedge biopsy, due to proximity of a large pulmonary arterial branch. 3D-CT images were invaluable in pre-operative assessment of the anatomy and were the key to safe completion of right VATS lower lobectomy. Sectioning the lung after retrieval of the specimen suggested a chondroid hamartoma;therefore, systemic nodal dissection (SND) was not contemplated. The final histology confirmed the diagnosis of chondroid hamartoma. In an unusual anatomy such as SIT, 3D-CT allows construction of virtual reality models that can be viewed and manipulated before and during the operation to understand the anatomy better, highlight caveats around target structures and enable localisation of lesions unlikely to be palpated intra-operatively.
文摘 Situs inversus totalis(SIT) is a rare anomaly in which the abdominal and thoracic cavity structures are opposite their usual positions.Occasionally,a few patients with a combination of this condition and malignant tumors have been encountered.Recently,several laparoscopic operations have been reported in patients with SIT.We report a case of an 83-year-old man with situs inversus totalis who developed colon cancer after open distal gastrectomy.Laparoscopic hemicolectomy with radical lymphadenectomy in such a patient was successfully performed by careful consideration of the mirror-image anatomy.Techniques themselves was not different from those in ordinary cases.Thus,curative laparoscopic surgery for colon cancer in the presence of situs inversus totalis is feasible and safe.
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.
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 Funds of Plastic Surgery Hospital of the Chinese Academy of Medical Sciences,Peking Union Medical College (No.YS202010)。
文摘AIM: To discover the molecular pathogenic basis of the blepharophimosis, ptosis, and epicanthus inversus syndrome(BPES), and to predict the clinical subtype according to in vitro experiments, which is significant to the prognosis.METHODS: A 3-year-old sporadic female patient with typical clinical manifestations of BPES was enrolled. The coding region of forkhead box L2(FOXL2) gene was sequenced, and the functional assays were performed in vitro by Western blotting, subcellular localization experiment, luciferase reporter assay, and quantitative realtime polymerase chain reaction.RESULTS: A novel FOXL2 point pathogenic variant(c.274G>T) was detected, resulting in a truncated protein(p.E92*). Functional studies demonstrated that the FOXL2 pathogenic variant induced the subcellular mislocalization and the abnormal transcriptional activity on promoters of the steroidogenic acute regulatory protein(StAR or STARD1) gene and the odd-skipped related 2 transcription factor(OSR2) gene.CONCLUSION: A novel pathogenic variant is identified to expand the spectrum of the known FOXL2 mutations. The in vitro experiments provide reference data and more insights to the molecular pathogenesis of BPES. The predicted high risk of ovarian insufficiency makes it significant for the patient enrolled to have further follow-up and therapy concerning female endocrinology.
文摘Situs inversus is a rare congenital anomaly referring to the mirror image of the abdominal and thoracic viscera. It can be discovered routinely or on the occasion of a complication related or not to situs inversus. We report a case of Situs inversus discovered incidentally during surgery for acute intestinal obstruction caused by an iatrogenic uterine perforation.
