Laparoscopic Adrenalectomy in a Patient with Situs Inversus

Kashiwagi, Shinichiro; Ishikawa, Tetsuro; Onoda, Naoyoshi; Kawajiri, Hidemi; Takashima, Tsutomu; Hirakawa, Kosei

doi:10.4293/108680813x13693422522114

Cited by 9 publications

(7 citation statements)

References 13 publications

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“…In those reports, the following three points were important for the success of the procedure: (i) sufficient preoperative discussion about the anatomy; (ii) reversal positioning of the surgeon, assistants, instruments, and monitors; and (iii) operation with care to avoid misidentification of the anatomy. It is important to visualize the organ position preoperatively and to perform a sufficient simulation of the procedure [ 17 , 18 ]. These factors also apply to the BRTO procedure.…”

Section: Discussionmentioning

confidence: 99%

The first case of balloon-occluded retrograde transvenous obliteration and partial splenic embolization for gastric varices in situs inversus abdominus

Watanabe

Osaki

Waguri

et al. 2021

Clin J Gastroenterol

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Situs inversus abdominus is a congenital abnormality characterized by the mirror image positioning of the abdominal organs, making it difficult to diagnosis and treatment of many diseases. Here, we report a rare case of gastric varices in situs inversus abdominus patient. A 55-year-old man was diagnosed with F2-shaped gastric varices associated with alcoholic cirrhosis. Abdominal dynamic computed tomography showed situs inversus abdominus, and gastric varices with a gastrorenal shunt. Due to the complex anatomy, emergency interventional radiology during bleeding was extremely difficult. Therefore, after thorough consultation, we decided to treat gastric varices prophylactically by balloon-occluded retrograde transvenous obliteration. After treatment, the patient’s clinical course was generally good, with no adverse events, and the gastric varices disappeared. It is important to assess anatomical positioning using three-dimensional reconstruction computed tomography images before treatment, to adequately prepare, including selecting appropriate devices (i.e., catheters and sheath). Although preventive treatment of gastric varices is controversial, in cases with anatomical complexity, preventive treatment with sufficient preparation would be recommended. To the best of our knowledge, there are no reports of treatment for gastric varices in situs inversus abdominus patient. This case will serve as a reference for successful treatment in future cases.

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Section: Discussionmentioning

confidence: 99%

The first case of balloon-occluded retrograde transvenous obliteration and partial splenic embolization for gastric varices in situs inversus abdominus

Watanabe

Osaki

Waguri

et al. 2021

Clin J Gastroenterol

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“…SIT is a congenital anomaly in the anatomy of human organs, since the first case was reported by Fabricus [7] in 1600. Although SIT is not considered as a risk factor for the development of malignant tumor, more than 60 cases of solitary cancer with SIT have already been reported including liver cancer, [8] gastric cancer, [9] colorectal cancer, [10] pancreatic cancer, [11] cholangiocarcinoma, [12] renal and adrenal tumors, [13,14] and leukemia. [15] Synchronous cancer in patients with SIT were also reported.…”

Section: Discussionmentioning

confidence: 99%

Solitary adrenal metastasis from advanced gastric cancer invading duodenal bulb with situs inversus totalis

Xue¹,

Li²,

Zhao³

et al. 2019

Medicine

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Rationale: Situs invsersus totalis (SIT) is a rare anomaly featured by complete inversion of abdominal and thoracic organs. Adrenal metastasis is often encountered as part of advanced systemic dissemination, which is usually unresectable. Few published cases reported the adrenal metastasis from gastric cancer with SIT and the treatment of gastrectomy combined with adrenalectomy, especially with intraoperative radiotherapy (IORT). Patient concerns: A 61-year-old SIT man found a mass on the right clavicle and the biopsy revealed a metastatic cancer. Around 14 years ago, he had a rectal cancer resection surgery and no sign of occurrence. Five months later, the patient had a pain in his right low abdomen and abdominal CT found a right adrenal mass. Diagnoses: Gastroscopy and the pathology revealed the gastric antrum cancer invading the duodenal bulb. Abdominal enhanced CT suspected the adrenal mass as a hematoma, but positron emission tomography computed tomography suspected it as the metastases of gastric cancer which is consistent with the pathology results. Finally, the SIT patient was diagnosed with primary gastric cancer invading duodenal bulb with solitary right adrenal metastasis. Interventions: The patient was treated with curative distal gastrectomy and Billroth-II anastomosis with D2 lymphadenectomy. A total 18 Gy intraoperative radiotherapy (IORT) using low energy x-rays by Intrabeam were given after resection. Outcomes: The patient had liver metastasis in the seventh month after surgery but there is no sign of local recurrence until now. Lessons: Gastric cancer with adrenal metastasis, especially with SIT is rare and intractable. The result suggested that active surgical treatment for resectable gastric cancer and solitary adrenal metastatic tumor, especially in combination with IORT may be an option in controlling local relapse and prolonging survival in selected patients.

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“…[6] reported a 45-year-old male with an adrenocortical adenoma. They operated the patient laparoscopically as we did.…”

Section: Discussionmentioning

confidence: 99%