Laparoscopic distal gastrectomy for advanced gastric cancer with situs inversus totalis: a case report

Abstract

Background Situs inversus totalis (SIT) is a relatively rare condition, in which the thoracic and abdominal organs are reversed or mirrored from their normal positions. Here, we reported a case of a patient with SIT and advanced gastric cancer with lymph node metastasis who underwent laparoscopic distal gastrectomy (LDG). Case presentation A 67-year-old man with SIT was clinically diagnosed with T3N2M0 advanced gastric cancer located in the middle gastric body. Three-dimensional reconstruction of computed tomography angiogram revealed that the common hepatic artery originated from the superior mesenteric artery. The patient underwent LDG with D2 lymph node dissection and Roux-en-Y reconstruction. The postoperative course was uneventful. Conclusion This case report showed that LDG could be safely performed on a patient even under complex conditions, such as advanced gastric cancer with lymph node metastasis with SIT and vascular anomalies.

Laparoscopy-assisted gastrectomy for advanced gastric cancer patients with situs inversus totalis: Two case reports and review of literature

“…The most common anomaly observed was that the CHA exited from the superior mesenteric artery, with three cases reported. The solution proposed by Fujita et al [ 24 ] re-confirmed the anatomical landmarks of LND in the suprapancreatic area as the upper borders of the pancreas, portal vein, and left gastric artery from the celiac axis. Therefore, during the preoperative evaluation period, sufficient imaging examination is necessary to detect the normal anatomy and variations in the branching pattern of the celiac trunk, which could significantly reduce the duration of surgery and the intraoperative blood loss.…”