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      Gastrostomy in a Patient with Situs Inversus Totalis

      case-report

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          Abstract

          Situs inversus totalis (SIT) is a rare condition in which there is complete right to left reversal of the abdominal and thoracic organs. SIT generally does not bear any pathophysiological significance, and the survival rate of patients with SIT does not differ from that of healthy individuals. However, patients with SIT require a thorough radiological examination to identify the presence of associated anatomic variations before undergoing invasive procedures such as surgery or hemostasis of gastrointestinal hemorrhage because they may have accompanying abnormalities in anatomical structures along with reversed organs. Percutaneous endoscopic gastrostomy (PEG) is a relatively safe procedure that is most commonly performed for the enteral feeding of patients with dysphagia and a normal gastrointestinal function. However, the procedure requires extracaution because minor complications may lead to life-threatening situations due to the underlying illnesses. Here, we report the case of a patient with SIT who underwent a PEG procedure without complications, and review the existing literature on this subject.

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          Most cited references19

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          Situs anomalies and gastrointestinal abnormalities.

          The aim of the study was to review the gastrointestinal abnormalities occurring in association with situs anomalies. Patients with situs anomalies were identified from the medical records of pediatric patients of Seoul National University Children's Hospital from January 1980 to July 2004. Retrospective study was undertaken. Diagnosis was made on the basis of the information obtained from a combination of echocardiography, angiography, abdominal ultrasonography, liver scan, upper gastrointestinal study, or abdominal computed tomography. A total 67 patients diagnosed as having situs anomalies were identified. There were 40 males and 26 females (1.54:1). Of these 67 patients, 45 patients (67%) were diagnosed as having situs inversus, 16 patients (24%) as having right isomerism, and 6 patients (9%) as having left isomerism. Of 45 patients with situs inversus, there were 26 patients (58%) who had intraabdominal abnormalities. These were duodenal atresia, biliary atresia, gastroschisis with malrotation, congenital hepatic fibrosis, tracheoesophageal fistula (type C), Currarino's triad, and pheochromocytoma. Of 16 patients with right isomerism, there were 14 patients (88%) who had intraabdominal abnormalities. These were hiatal hernia and diaphragmatic hernia. Of 6 patients with left isomerism, there were 4 patients (67%) who had intraabdominal abnormalities. These were malrotation and biliary atresia. When a patient is noted to have congenital heart disease as part of situs anomalies, or if an atypical position of organs is noted at imaging evaluation, we recommend that the patient undergo chest radiography, abdominal ultrasonography, upper gastrointestinal study, and abdominal computed tomography.
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            American Gastroenterological Association technical review on tube feeding for enteral nutrition.

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              Laparoscopic hemicolectomy in a patient with situs inversus totalis.

              As among persons with normal anatomy, occasional patients with situs inversus develop malignant tumors. Recently, several laparoscopic operations have been reported in patients with situs inversus. We describe laparoscopic hemicolectomy with radical lymphadenectomy in such a patient. Careful consideration of the mirror-image anatomy permitted safe operation using techniques not otherwise differing from those in ordinary cases. Thus, curative laparoscopic surgery for colon cancer in the presence of situs inversus is feasible and safe.
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                Author and article information

                Journal
                Clin Endosc
                Clin Endosc
                CE
                Clinical Endoscopy
                The Korean Society of Gastrointestinal Endoscopy
                2234-2400
                2234-2443
                November 2013
                19 November 2013
                : 46
                : 6
                : 662-665
                Affiliations
                Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.
                Author notes
                Correspondence: Kwang Bum Cho. Department of Internal Medicine, Keimyung University School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 700-712, Korea. Tel: +82-53-250-7088, Fax: +82-53-250-7088, chokb@ 123456dsmc.or.kr
                Article
                10.5946/ce.2013.46.6.662
                3856270
                24340262
                9f5661b2-0daa-4a30-ba34-59e5debe5237
                Copyright © 2013 Korean Society of Gastrointestinal Endoscopy

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 14 December 2012
                : 13 February 2013
                : 18 April 2013
                Categories
                Case Report

                Radiology & Imaging
                percutaneous endoscopic gastrostomy,situs inversus totalis,anatomic variation

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