Elfanagely Omar, Elfanagely Yousef, Pratt Abimbola
Department of Surgery, Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Department of Internal Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Int J Surg Case Rep. 2021 Oct;87:106456. doi: 10.1016/j.ijscr.2021.106456. Epub 2021 Sep 27.
Situs inversus totalis (SIT) is a rare anatomical variation of the thoracic and abdominal organs. It is a congenital anomaly with an incidence of 1:10,000 to 1:20,000. Patients with SIT do not have a decreased survival rate as compared to patients without SIT because SIT generally does not have a pathophysiologic significance. However, the anatomical variations in SIT can cause some challenges when assessing intraabdominal and intrathoracic symptoms or performing operations.
We report a case of a 93-year-old woman with a past medical history of hypertension, hyperlipidemia, atrial fibrillation, and situs inversus totalis who presented with diffuse abdominal pain for 4 days. Abdominal exam was significant for diffuse tenderness. Computed tomography (CT) imaging was significant for pneumoperitoneum. She emergently underwent an exploratory laparotomy, descending hemicolectomy and left in discontinuity with an open abdomen. On postoperative day 2 she underwent a stamm feeding gastrostomy tube, incisional hernia repair, and maturation of end colostomy. Her remaining hospital course was complicated by a pelvic collection, which was managed by a percutaneous guided drain placement. She was ultimately discharge to rehab on hospital day 15.
SITS can present a particularly challenging situation to clinical diagnoses and surgical procedures. However, when identified, these patients should warrant special considerations prior to proceeding with surgical intervention. This includes radiologic imaging and proper planning prior to the operating room, when possible.
We herein present a case of colonic perforation in a patient with situs inversus totalis. Proper planning, thorough imaging, and careful execution are necessary to ensure patient safety and care in patients with SIT. However, in the case of emergency this should not delay definitive management.
全内脏转位（SIT）是一种罕见的胸腹部器官解剖变异。它是一种先天性异常，发病率为1:10000至1:20000。与无SIT的患者相比，SIT患者的生存率并未降低，因为SIT通常不具有病理生理学意义。然而，SIT中的解剖变异在评估腹内和胸内症状或进行手术时可能会带来一些挑战。
我们报告一例93岁女性患者，既往有高血压、高脂血症、心房颤动和全内脏转位病史，因弥漫性腹痛4天就诊。腹部检查发现弥漫性压痛。计算机断层扫描（CT）成像显示有气腹。她紧急接受了剖腹探查术、降结肠切除术，并使左半结肠不连续，腹部开放。术后第2天，她接受了 Stamm 喂养胃造瘘管置入、切口疝修补和末端结肠造口成熟术。她在医院的剩余病程因盆腔积液而复杂化，通过经皮引导下放置引流管进行处理。她最终在住院第15天出院接受康复治疗。
SIT对临床诊断和外科手术可能是一种特别具有挑战性的情况。然而，一旦确诊，在进行手术干预之前，这些患者应给予特殊考虑。这包括在可能的情况下，在进入手术室之前进行放射学成像和适当的规划。
我们在此报告一例全内脏转位患者的结肠穿孔病例。为确保SIT患者的安全和护理，需要进行适当的规划、全面的成像和仔细的操作。然而，在紧急情况下，这不应延迟确定性治疗。
