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COMMENTARY
Year : 2019  |  Volume : 12  |  Issue : 2  |  Page : 169  

Situs inversus totalis associated with cancer: Report of 3 rare cases and review of literature


Department of Pathology, Sri Devaraj Urs Medical College, Kolar, Karnataka, India

Date of Web Publication25-Mar-2019

Correspondence Address:
Subhashish Das
Department of Pathology, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_91_18

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How to cite this article:
Das S. Situs inversus totalis associated with cancer: Report of 3 rare cases and review of literature. Med J DY Patil Vidyapeeth 2019;12:169

How to cite this URL:
Das S. Situs inversus totalis associated with cancer: Report of 3 rare cases and review of literature. Med J DY Patil Vidyapeeth [serial online] 2019 [cited 2019 Jun 16];12:169. Available from: http://www.mjdrdypv.org/text.asp?2019/12/2/169/254785



Situs inversus totalis (SIT) is a rare congenital condition characterized by a mirror-image transposition of both the abdominal and thoracic viscera; its incidence accounts for 1/8000–1/25,000 of the normal population.[1] This condition may cause difficulties in the diagnosis and therapeutic management of abdominal pathology. An increased risk of cardiac, splenic, and hepatobiliary malformations is found in patients with SIT.

SIT is an uncommon entity that often occurs concomitantly with other abnormalities. The relationship between SIT and cancer is not approved; further, studies are needed to identify precisely genetic and molecular patterns involved in the development of malignancy in these patients. Because of the frequency of associated malformations of transposed organs and vascular and nervous anatomical variations that make difficult surgical management, special attention should be paid to the diagnosis and preoperative staging.[2]

It is worthwhile noting that traditionally patients with situs inversus present with signs, which may be difficult to interpret such as those of appendicitis or cholecystitis. When surgery is anticipated patients with situs inversus, there is need to carefully plan and evaluate the location of the skin incision. The malignancy potential must be borne in mind in all cases of situs inversus.[3]

Surgical procedures are considered more difficult in patients with situs inversus than other patients because of the different anatomic position of organs, especially in laparoscopic surgery. The preoperative evaluation for situs inversus includes two main objectives as follows: evaluation for gastrointestinal and cardiac anomalies and orientation of the viscera. The extent of evaluation should be based on the complexity of the procedure.[4] Anomalies should be defined using various imaging technologies to determine appropriate surgical treatment and decrease surgical difficulties and time. Furthermore, the risk of occurrence of intraoperative complications is higher in comparison with the procedures of patients without SIT. Besides, incorrect surgical incision and a second operation are avoided.[5]



 
  References Top

1.
Bielecki K, Gregorczyk M, Baczuk L. Visceral situs inversus in three patients. Wiad Lek 2006;59:707-9.  Back to cited text no. 1
    
2.
Blegen HM. Surgery in situs inversus. Ann Surg 1949;129:244-59.  Back to cited text no. 2
    
3.
Fujiwara Y, Fukunaga Y, Higashino M, Tanimura S, Takemura M, Tanaka Y, et al. Laparoscopic hemicolectomy in a patient with situs inversus totalis. World J Gastroenterol 2007;13:5035-7.  Back to cited text no. 3
    
4.
Goi T, Kawasaki M, Yamazaki T, Koneri K, Katayama K, Hirose K, et al. Ascending colon cancer with hepatic metastasis and cholecystolithiasis in a patient with situs inversus totalis without any expression of UVRAG mRNA: Report of a case. Surg Today 2003;33:702-6.  Back to cited text no. 4
    
5.
Greene QJ, Cheadle WG. Ascending colon cancer in a patient with situs inversus. Am Surg 2007;73:831-2.  Back to cited text no. 5
    




 

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