Situs inversus totalis: A challenge for cardiac resynchronization therapy.

Situs inversus totalis (SIT) is a congenital condition in which the major visceral organs are reversed or in a mirror image from their normal positions that affects one per 10,000 live births. It is associated with dextrocardia (DXC) in which the heart is located on the right side of the chest. We present a challenging cardiac resynchronization therapy (CRT) implantation in a 60-year-old man with SIT-DXC, heart failure, extreme bradycardia, wide QRS, and left ventricular (LV) dysfunction. The procedure was complex due to the mirror-image anatomy and the tortuous origin of the coronary sinus (CS) branches that required a subselection catheter for adequate lead implantation.

Colecistectomía laparoscópica en una paciente con situs inversus totalis. Reporte de un caso y revisión de la literatura

Introducción: El situs inversus totalis es una condición congénita en la cual los órganos torácicos y abdominales se encuentran en posición contraria a la posición habitual. En la literatura quirúrgica internacional se encuentran publicados no más de 55 casos de colecistectomía en pacientes con situs inversus totalis. La resolución laparoscópica de una paciente en nuestra Institución nos permite revisar esta particular condición patológica. Caso Clínico: Paciente femenino de 43 años de edad hospitalizada por una colecistitis aguda la cual es resuelta por vía laparoscópica sin incidentes. Material y Método: Se resume la literatura actual mediante una extensa revisión en PubMed de los reportes más relevantes. Considerando que todos los artículos publicados son casos clínicos o pequeñas series de casos, se presentan los resultados de esta revisión en tablas con estadística descriptiva básica. Discusión: Se discuten las características generales de estos pacientes, la presentación clínica, diagnóstico y técnica quirúrgica. Conclusión: La colecistectomía laparoscópica constituye el estándar de oro en pacientes con situs inversus y patología biliar, la cual debe ser realizada por un cirujano experimentado acomodando los trocares apropiadamente, debido a las dificultades técnicas que se encuentran en estos pacientes por las anomalías anatómicas propias de esta condición. El diagnóstico radiológico actual permite la planificación del abordaje y del procedimiento quirúrgico apropiado para cada paciente.

Introduction: Situs inversus totalis is a congenital condition in which the thoracic and abdominal organs are in the opposite position from normal anatomy. We found no more than 55 cases of cholecystectomy in patients with situs inversus totalis published in the international surgical literature. The laparoscopic resolution of a patient in our Institution allows us to review this particular pathological condition. Clinical Case: A 43-year-old female patient was admitted for acute cholecystitis and was resolved laparoscopically without any incidents. Material and Method: We summarized the current literature through an extensive PubMed review of the most relevant reports. Considering that all published articles are clinical cases or small case series, we present the results of this review in a table with basic descriptive statistics. Discussion: We discuss the general characteristics of these patients, clinical presentation, diagnosis, and surgical technique. Conclusions: Laparoscopic cholecystectomy is the gold standard in patients with situs inversus and biliary pathology, which must be performed by an experienced surgeon, properly accommodating the trocars due to the technical difficulties in these patients secondary to anatomical anomalies typical of this condition. Current radiological diagnosis allows planning the appropriate approach and surgical procedure for each patient.

Apendicitis aguda no complicada en situs inversus totalis. Reporte de un caso

Introducción: El situs inversus totalis es una malformación congénita rara, caracterizado por una posición invertida de los órganos torácicos y abdominales, influyendo negativamente en la aproximación diagnóstica y en el tratamiento quirúrgico. Reporte: Se diagnosticó apendicitis aguda en un paciente varón de 28 años que conocía su anormalidad anatómica y se corroboró con imágenes tomográficas y la exploración laparoscópica. Ingresó a emergencia con 30 horas de dolor abdominal con inicio en epigastrio y posterior irradiación hacia la fosa iliaca izquierda. La tomografía confirmó su condición de situs inversus totalis y signos patológicos en la apendicitis localizada en FII; se realizó la intervención por laparoscopia sin complicaciones. Discusión: En pacientes con dolor en el cuadrante inferior izquierdo es importante un adecuado diagnóstico diferencial y el conocimiento previo de una anormalidad anatómica comunicada oportunamente hace viable un diagnóstico adecuado y una resolución quirúrgica exitosa.

Introduction: Situs inversus totalis is a rare congenital malformation, characterized by an inverted position of the thoracic and abdominal organs, negatively influencing the diagnostic approach and surgical treatment. Report: Acute appendicitis was diagnosed in a 28-year-old male patient who knew his anatomical abnormality and was corroborated with tomographic images and laparoscopic exploration. He was admitted to the emergency room with 30 hours of abdominal pain with onset in the epigastrium and subsequent radiation to the left iliac fossa. The tomography confirmed his condition of situs inversus totalis and pathological signs in localized appendicitis in FII; The laparoscopic intervention was performed without complications. Discusions: In patients with pain in the left lower quadrant, an adequate differential diagnosis is important and prior knowledge of an anatomical abnormality communicated in a timely manner, that makes feasible an adequate diagnosis and successful surgical resolution.

Acute cholecystitis in a situs inversus totalis. Case report.

INTRODUCTION: Situs inversus totalis (SIT) is an autosomal recessive congenital disorder. Acute cholecystitis is a diagnosis challenge in patients with SIT. CLINICAL CASE: A 26-year-old female who presented with atypical gallbladder colic. Assessed by Surgery, concluding diagnosis of acute cholecystitis and SIT. Laparoscopic cholecystectomy was performed. DISCUSSION: SIT is a rare congenital pathology, defined by the transposition of thoracic and abdominal viscera. Most patients are asymptomatic and they're discovered incidentally. The SIT goes far beyond the paradigm of treatments and surgical techniques. CONCLUSIONS: The pathology turns into a behavior modification for surgical treatment, however, it is possible to carry them out successful procedure.

INTRODUCCIÓN: El situs inversus total (SIT) es un trastorno congénito autosómico recesivo. La colecistitis aguda es un reto diagnóstico en los pacientes con SIT. CASO CLÍNICO: Mujer de 26 años con cólico vesicular atípico. Valorada por cirugía, se concluye el diagnóstico de colecistitis aguda y SIT. Se realiza colecistectomía laparoscópica, sin complicaciones. DISCUSIÓN: En el SIT definido por transposición de vísceras torácicas y abdominales, la mayoría de los pacientes son asintomáticos y se descubre incidentalmente. El SIT supera el paradigma de tratamientos y técnicas quirúrgicas. CONCLUSIONES: Esta patología requiere modificación de conductas para el tratamiento quirúrgico, pero es posible realizarlo con éxito.

Multiple stab wounds on the left side of the chest in a patient with Situs Inversus Totalis: A lifesaving coincidence.

INTRODUCTION: Situs Inversus Totalis (SIT) is a rare finding of complete reversal of the thoracic and abdominal organs with an estimated incidence of 0.005%-0.01% in the population. Severe trauma has not been reported in this population. We present a case of multiple chest stab wounds in a patient with previously unknown SIT. PRESENTATION OF CASE: A 39-year-old male was admitted to the emergency room with multiple stab wounds on the left side of the chest. Upon admission the patient was hypotensive, with miosis and intubated. Significant ECG findings were an inverted P wave, inverted QRS complex and inverted T wave in V1. A chest CT scan showed SIT, hemopneumothorax on the left side and, despite multiple stab wounds on the left side of the chest, no cardiac damage. The surgical team decided for a conservative approach and the patient remained in the ICU for two days. After five days he was discharged in good clinical conditions. DISCUSSION: SIT generally does not have a clinical relevance throughout the patients life and most diagnoses are coincidental. However, when discovered in acute surgical cases, it requires an accurate evaluation by the surgical team due to anatomical differences that may produce undesirable outcomes in emergency cases such as appendicitis and general trauma. CONCLUSION: There have been very few reports of SIT and trauma in the medical literature. This might be the first ever reported case of a patient with SIT who suffered multiple stab wounds on the left side of the chest and was saved because of his condition.

Dextrocardia and situs inversus totalis in a Turkish subject: a case report / Dextrocardia y situs inversus totalis en un sujeto turco: reporte de un caso

Dextrocardia with situs inversus is an uncommon anomaly affecting about 1 to 2 per 10,000 in the general population. This report describes an adult male patient with dextrocardia and in a Turkish subject. The photographic illustrations revealed transposition of some of the visceral organs such as the spleen was located right and the liver and gall bladder on the left. The heart was flattened and flipped to the right. Many people with situs inversus totalis are unaware of their unusual anatomy until they seek medical attention for an unrelated condition. So, early detection may lead to a successful surgical management and consequently offer a safer chance of survival. This report showed that dextrocardia and situs inversus can be seen amongst Turkish subjects.

La dextrocardia con situs inversus es una anomalía poco frecuente que afecta aproximadamente de 1 a 2 personas por 10.000 en la población general. Este informe describe un paciente masculino adulto con dextrocardia. Las figuras revelaron que la transposición de algunos de los órganos viscerales, como el bazo, se ubicada a la derecha y el hígado y la vesícula biliar a la izquierda. El corazón fue aplastado y girado hacia la derecha. Muchas personas con situs inversus totalis desconocen su anatomía inusual hasta que buscan atención médica por una afección no relacionada. Por lo tanto, la detección temprana puede llevar a un manejo quirúrgico exitoso y, en consecuencia, ofrecer una posibilidad más segura de supervivencia. Este informe mostró que la dextrocardia y el situs inversus se pueden encontrar entre los sujetos turcos.

Case Reports of Situs Inversus Totalis and Dextrocardia in Sprague Dawley Rats.

Situs inversus totalis is a condition where there is a transposition of all internal organs from their normal anatomical location. This infrequent and rare congenital condition has been described in several species of mammals. Dextorcardia is a series of conditions associated with an abnormal congenital positioning of the heart, and is often associated with situs inversus totalis. Here we report a case of situs inversus totalis and two cases of dextrocardia identified in Sprague Dawley rats during gross necropsy evaluations at both the Health Sciences North Research Institute (HSNRI) in Canada and Finlay Institute of Vaccine Research and Production in Cuba. The intent of this report is to share our findings and aid in the accumulation of data on these rare conditions.

Colecistectomía laparoscópica en situs inversus totalis / Laparoscopic cholecystectomy in situs inversus totalis

Situs inversus totalis es una anomalía congénita poco frecuente. Se caracteriza por la transposición de los órganos tóraco-abdominales en sentido sagital al brindar una imagen llamada en espejo. Reportamos paciente de 59 años con diagnóstico de litiasis vesicular y situs inversus totalis resuelto por colecistectomía videolaparoscópica, en el Hospital Universitario Comandante Manuel Fajardo de La Habana. El cuadro clínico tuvo seis meses de evolución, con dolor a tipo cólico en hipocondrio izquierdo acompañado de náuseas, que se relacionaban con la ingestión de alimentos colecistoquinéticos. Los exámenes de laboratorio estuvieron dentro de parámetros normales. La ecografía abdominal informó litiasis vesicular, así como, el situs inversus totalis que se confirmó con Rayos X de tórax. Su evolución posoperatoria, luego de un año, fue satisfactoria, la cual mostró la factibilidad de la técnica quirúrgica empleada(AU)

Situs inversus totalis (SIT) is a rare congenital anomaly characterized by the transposition of the thoracic-abdominal organs towards the sagittal direction, producing an image called in mirror. The case is presented of a 59-year-old female patient, with a diagnosis of vesicular lithiasis and situs inversus totalis for cholelithiasis, treated by laparoscopic cholecystectomy in Comandante Manuel Fajardo University Hospital of Havana. The patient's clinical picture had a natural history of 6 months, with left colic pain in the left hipocondrium, with nauseas, accentuated on ingestion of greasy meals. The laboratory test results showed normal parameters. X-rays of the abdomen confirmed vesicular cholestasis and situs inversus totalis. The patient's postoperative evolution after one year was satisfactory, showing the feasibility of the surgical technique used(AU)

Laparoscopic hemicolectomy for a patient with situs inversus totalis and colorectal cancer / Colectomia laparóscopica para um paciente com situs inversus totalis e câncer colorretal

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.

RESUMO Situs inversus totalis é uma anomalia anatómica consistindo em um investimento de órgãos abdominais. Nesse estudo, descrevemos um paciente, homem 67 anos, que foi diagnosticado com situs inversus totalis na infância. Apresentava sintomas de sangramento retal e foi diagnosticado com câncer de cólon direito e tratado cirurgicamente com receção laparoscópica. Para a realização da colectomia laparoscopica precisamos de um estudo pré-operatória completa e um plano detalhado de cirurgia com localização do trocateres e cirurgiões. A cirurgia durou 120 minutos e perde de sangue foi mínima. O resultado do exame patológico relatou adenocarcinoma (T3N0). Nosso paciente foi admitido por 7 dias e não apresentaram complicações. Para os pacientes com situs inversus totalis e câncer colorretal a receção laparoscópica pode ser mais difícil mas eficaz e segura.

Pectus Excavatum e Situs Inversus Totalis: um relato de caso / Pectus excavatum and situs inversus totalis: a case report

O Pectus Excavatum consiste em uma deformidade óssea torácica caracterizada, basicamente, pela depressão do esterno e das cartilagens costais inferiores, podendo cursar com alterações da extremidade anterior das costelas na sua articulação com as cartilagens costais. Ademais, o Situs Inversus Totalis (STI) é caracterizado pelo desenvolvimento das vísceras no lado oposto de sua topografia habitual acompanhada de dextrocardia; ápice cardíaco voltado para a direita. Os autores relatam um caso combinado de Pectus Excavatum e Situs Inversus Totalis em um paciente jovem, do sexo masculino, diagnosticado no período da puberdade e discutem brevemente acerca de uma revisão literária do caso(AU)

Pectus excavatum is a chest bone deformity characterized primarily by depression of the sternum and the lower costal cartilages, which may be accompanied by changes in the anterior end of the ribs in its articulation with rib cartilage. In addition, the situs inversus totalis (SIT) is characterized by the development of the viscera on the opposite side of its usual topography accompanied by dextrocardia; cardiac apex facing the right. The authors report a combined case of pectus excavatum and situs inversus totalis in a young male patient diagnosed in the puberty period and briefly discuss about a literature review of the case(AU)

Situs Inversus totalis, dextrocardia y fisura labio- palatina / Situs inversus totalis, dextrocardia and fissure cleft lip a case by the wa

El Situs Inversus Totalis con dextrocardia es una rara entidad congénita caracterizada por la posición invertida de los órganos torácicos y abdominales en lo que respecta al eje derecha-izquierda, se le conoce como imagen en espejo y es resultado de anomalías en la rotación del tubo cardiaco durante el desarrollo embrionario; con una frecuencia de 1/10 000 nacidos vivos, su etiología no es clara pero se cree que es debido a un rasgo genético autosómico recesivo. Esta malformación usualmente va asociada a otras malformaciones, y a otras enfermedades genéticas como el Síndrome de Kartagener y el Síndrome de Ivemark; pudiendo ser diagnosticada prenatalmente. Se reporta el caso de una paciente pediátrica de 5 años de edad que fue atendida por presentar hemorragia digestiva alta, con antecedentes previos de Situs Inversus Totalis, dextrocardia, atresia de la arteria pulmonar y fisura labio-palatina.

Dextrocardia with Situs InversusTotalis is a rare congenital condition characterized by the inverted position of the thoracic and abdominal organs in regard to the left-right axis, it is known as mirror image and is the result of anomalies in the rotation of the heart tube during embryonic development; with a frequency of 1/ 10 000 live births, its etiology is unclear but is believed to be due to an autosomal recesive genetic ership. This malformation is usually associated with other malformations,and other genetic diseases like Kartagener syndrome and syndrome Ivemark; can be diagnosed prenatally. Patient 5 year of age was attended by upper gastrointestinal bleeding present with previous history of Situs InversusTotalis, dextrocardia, pulmonary artery atresia and cleft lip and palate is reported.

Síndrome de Kartagener em um cão (Canis lupus familiaris) da raça Cocker Spaniel Inglês / Kartagener's syndrome in an English Cocker Spaniel dog (Canis lupus familiaris)

Kartagener is syndrome is a rare disorder described in dogs determined by the triad situs inversus totalis, chronic sinusitis, and bronchial disease. The clinical signs of chronic respiratory and other less common presentations (such as hydrocephalus and subfertility) are due to a concomitant ciliary dysfunction. This article describes the clinical, radiographic, and computed tomography findings and treatment in a dog affected by Kartagener is syndrome since early months of life. This is the first case report of this syndrome in a domestic dog in Brazil and the only known scientific report in the English Cocker Spaniel.

Síndrome de Kartagener em um cão (Canis lupus familiaris) da raça Cocker Spaniel Inglês / Kartagener's syndrome in an English Cocker Spaniel dog (Canis lupus familiaris)

Kartagener is syndrome is a rare disorder described in dogs determined by the triad situs inversus totalis, chronic sinusitis, and bronchial disease. The clinical signs of chronic respiratory and other less common presentations (such as hydrocephalus and subfertility) are due to a concomitant ciliary dysfunction. This article describes the clinical, radiographic, and computed tomography findings and treatment in a dog affected by Kartagener is syndrome since early months of life. This is the first case report of this syndrome in a domestic dog in Brazil and the only known scientific report in the English Cocker Spaniel.(AU)

Three-port laparoscopic cholecystectomy in a brazilian Amazon woman with situs inversus totalis: surgical approach.

Situs inversus totalis (SIT) is an uncommon anomaly characterized by transposition of organs to the opposite side of the body in a mirror image of normal. We report on an adult woman, born and resident in Brazilian Amazonia, presenting acute pain located at the left hypochondrium and epigastrium. During clinical and radiological evaluation, the patient was found to have SIT and multiple stones cholelithiasis. Laparoscopic cholecystectomy was safely performed with the three-port technique in a reverse fashion. In conclusion, this case confirms that three-port laparoscopic cholecystectomy is a safe and feasible surgical approach to treat cholelithiasis even in rare and challenging conditions like SIT.

Corpo estranho iatrogênico: uma lição para todos / Iatrogenic foreign body: a lesson for all

Situação extremamente desagradável e difícil para o cirurgião que se depara com esta patologia durante o ato cirúrgico, devido ao envolvimento ético e judicial importantes, somado ao trauma psicológico junto ao paciente e aos seus familiares. O presente trabalho versa sobre o caso de uma paciente com situs inversus totalis, em preparo eletivo para ressecção de volumosa tumoração em flanco esquerdo.

Extremely unpleasant and difficult situation for the surgeon that come across this pathology during the surgical act, due to the ethical and judicial involvement added to the psychological trauma next to the patient and their family. In this case we have a patient with in situs inversus totalis, in prepare for a surgical procedure to remove a cystic tumor in left flank, and after the surgery,a surprise: a foreign body with 18 years old.