Laparoscopic hemicolectomy for a patient with situs inversus totalis and colorectal cancer

Abstract

Situs inversus totalis is a congenital anatomic anomaly characterized by a complete inversion of thoracic and abdominal organs. We present a case of a 67 year-old patient diagnosed with situs inversus totals in his childhood who was referred for a two-month history of hematoquezia. Ascending colon cancer where found and he underwent a laparoscopic hemicolectomy with radical lymphadenectomy. An exhaustive preoperative study and a detailed planning of laparoscopic surgery including positions of operator and assistants and trocar sites have been performed to be aware of anatomic challenges. The operating time was 120 min and blood loss was minimal. Histologic examination showed a well-differentiated adenocarcinoma with serosal invasion and without lymph nodes metastasis (pT3N0). The patient was discharged on postoperative 6th day without complications. Laparoscopic surgery for colon cancer in patients with situs inversus totalis could be more difficult nevertheless a safe and feasible procedure should be performed successfully.

Association between types of abdominopelvic cancer in patients with situs inversus total: Systematic review

“…In the present study, 41 [7–47] case reports that included SIT and some type of cancer in the abdominal-pelvic region were analyzed. In the 41 reports, a total of 46 patients were analyzed, of which 19 (41.30%) correspond to female patients and 27 (58.70%) correspond to male patients.…”

Colecistite calculosa em situs inversus totalis: abordagem laparoscópica

“…Apresenta-se com dextrocardia e completa transposição das vísceras abdominais, dando a chamada "imagem especular", sendo menos frequente nos homens, e apresenta associação com outros distúrbios congênitos, a exemplo da síndrome de Kartagener . A maioria dos casos é detectada durante exames médicos usando radiografia simples de tórax 6,7 ou outros exames de imagem como ultrassonografia e tomografia computadorizada quando solicitados para avaliar uma queixa clínica ou quando se tenha uma forte suspeita da presença do situs inversus 8 . No presente caso, a paciente e seus dois irmãos apresentam situs inversus totalis sem alterações funcionais, o que leva a crer da possibilidade do caráter genético dessa variação anatômica 2 .…”

Laparoscopic colon resection in patients with situs inversus totalis: Is it the same operation as in patients without situs inversus totalis?

“…Although there are some technical differences between surgeons and surgical teams while performing such operations, it can be performed successfully by a well pre-operative planning and preparation. [ 7 ] The surgeon and the assistant should be at the left side of the patient as in the laparoscopic right colon surgery, and the trocar placement should be the same to the mirror image of standard sigmoid colon surgery. During dissection, clipping and use of laparoscopic instruments including stapler by the left hand of the surgeon may be a limiting factor for right-handed surgeons.…”