Situs InversusTotalis with Malposition of Caecum and Ascending colon

Abstract

Situs Inversus Totalis (SIT) is an inversion anomaly involving the position of abdominal and thoracic viscera with respect to the midline. The medical and surgical management of these patients are technically more challenging because of the mirror image location of the viscera. The objective of the present case report is to document a rare case of SIT associated with malposition of caecum and ascending colon. A routine gross anatomy dissection was carried out for demonstration for the undergraduate students, in a formalin fixed female cadaver. Abdominal and thoracic region dissection was carried out following standard procedures. An inversion anomaly associated with malposition of colon was encountered, which was documented appropriately. Inversion anomaly of abdominal organs was observed with the liver on the left and stomach and spleen situated on the right side of the body. The position of large intestine per se was lower and it was found that the caecum and appendix was located deep down, in the left pelvic region with a short segment of ascending colon. In the pelvis, uterus was identified and was retroverted in position. Further, dissection of the thoracic region confirmed dextrocardia in the same cadaver. The position of great vessels in the thorax and the abdomen were also inverted with regards to the midline. These anatomical variations should be kept in mind during clinical and radiological examination in patients presenting with unusual signs and symptoms of abdominal region. Further, inversion of technical procedures is mandatory for effective surgical management of such SIT cases.

Keywords

• dextrocardia
• heterotaxy
• inversion anomaly
• kartagener’s syndrome
• lateralization defect