Tayeb Mohammad, Khan Faiz Mohammad, Rauf Fozia
Department of Surgery, Peshawar Medical College, Peshawar, Pakistan.
J Med Case Rep. 2011 Jul 3;5:279. doi: 10.1186/1752-1947-5-279.
Situs inversus is an uncommon anomaly. Situs inversus viscerum can be either total or partial. Total situs inversus, also termed as mirror image dextrocardia, is characterized by a heart on the right side of the midline while the liver and the gall bladder are on the left side. Patients are usually asymptomatic and have a normal lifespan. The exact etiology is unknown but an autosomal recessive mode of inheritance has been speculated. The first case of perforated duodenal ulcer with situs inversus was reported in 1986; here, we report the second case of this nature in the medical literature.
A 22-year-old Pakistani man presented with severe epigastric and left hypochondrial pain. Examination and investigations (chest X-ray and ultrasonography) confirm peritonitis in a case of situs inversus totalis. On exploratory laparotomy, a diagnosis of situs inversus totalis with perforated duodenal ulcer was confirmed. Graham's patch closure of the duodenal ulcer was performed with absorbable sutures, and a thorough peritoneal lavage was also performed; an incidental appendectomy was also performed to avoid further diagnostic problems. Our patient had an uneventful recovery.
A diagnostic dilemma arises whenever abdominal pathology occurs in patients with situs inversus. Although an uncommon anomaly, to choose a proper surgical incision site for abdominal exploration pre-operative recognition of the condition is important.
内脏反位是一种罕见的异常情况。内脏反位可分为完全性或部分性。完全性内脏反位，也称为镜像右位心，其特征是心脏位于中线右侧，而肝脏和胆囊位于左侧。患者通常无症状，寿命正常。确切病因尚不清楚，但推测为常染色体隐性遗传模式。1986年报道了首例伴有内脏反位的十二指肠溃疡穿孔病例；在此，我们报告医学文献中第二例此类病例。
一名22岁的巴基斯坦男性因严重上腹部和左季肋部疼痛就诊。检查和调查（胸部X线和超声检查）证实为完全性内脏反位伴腹膜炎。在剖腹探查术中，证实为完全性内脏反位伴十二指肠溃疡穿孔。用可吸收缝线进行了十二指肠溃疡的格雷厄姆补片缝合，并进行了彻底的腹腔灌洗；还进行了阑尾切除术以避免进一步的诊断问题。我们的患者恢复顺利。
当内脏反位患者出现腹部病变时，就会出现诊断难题。尽管这是一种罕见的异常情况，但术前识别该情况对于选择合适的腹部探查手术切口部位很重要。
