Osime O C, Osime U, Njoku T, Adeyekun A A, Obonna G, Okoro E, Obaseki D, Igbe A
Department of Surgery, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.
West Afr J Med. 2007 Jul-Sep;26(3):246-9.
Cases of a case of situs inversus totalis are very rare and therefore when encountered, they are likely to be missed or poorly managed.
To present a case of situs inversus totalis with a view to creating more awareness about this rare clinical entity.
The patient, a 22 year old boy was referred from a private clinic after a failed and complicated attempted appendicectomy carried out by a general medical practitioner. The patient was admitted, resuscitated and had investigations done. Some of the investigations done were abdominal ultrasound scan, computerized axial tomography scan, a chest x ray, complete blood count, urinalysis and electrolyte and urea.
Investigations showed features of situs inversus totalis. There was also bilateral hydronephrosis, worse on the right side. The patient also had features of renal failure. He died after three days on admission. Autopsy finding confirmed bilateral pyonephrosis which was worse on the right side. There was associated urethral fibrosis. Cause of death was urethral fibrosis resulting in obstructive uropathy, pyonephrosis and renal failure.
Situs inverses totalis is rare but can psented in diverse ways and thus the diagnosis may be missed and the patient wrongly managed. A high index of clinical suspicion is required if we the diagnosis is to be made early and wrong treatments avoided.
全内脏转位的病例非常罕见，因此一旦遇到，很可能被漏诊或处理不当。
介绍一例全内脏转位病例，以期提高对这种罕见临床病症的认识。
该患者为一名22岁男孩，在一名全科医生进行的阑尾切除术失败且出现并发症后，从一家私人诊所转诊而来。患者入院后接受复苏并进行了检查。所做的检查包括腹部超声扫描、计算机断层扫描、胸部X光、全血细胞计数、尿液分析以及电解质和尿素检查。
检查显示为全内脏转位特征。同时还存在双侧肾积水，右侧更为严重。患者也有肾衰竭的特征。入院三天后死亡。尸检结果证实双侧肾盂积脓，右侧更为严重。伴有尿道纤维化。死亡原因是尿道纤维化导致梗阻性尿路病、肾盂积脓和肾衰竭。
全内脏转位罕见，但可能以多种方式呈现，因此可能会漏诊，患者也可能得到错误的治疗。如果要早期做出诊断并避免错误治疗，需要高度的临床怀疑指数。
