Pancreaticoduodenectomy for biliary tract carcinoma with situs inversus totalis: difficulties and technical notes based on two cases

World Journal of Surgical Oncology
Daisuke KyunoKoichi Hirata

Abstract

Situs inversus totalis (SIT) denotes complete right-left inversion of the thoracic and abdominal viscera. Diagnosis and surgical procedures for abdominal pathology in patients with SIT are technically more complicated because of mirror-image transposition of the visceral organs. Moreover, SIT is commonly associated with cardiovascular and hepatobiliary malformations, which make hepatobiliary-pancreatic surgery difficult. Two cases of pancreaticoduodenectomy for biliary tract carcinoma in patients with SIT are presented. Both patients had an anomaly of the hepatic artery. Advanced diagnostic imaging techniques were very important for careful preoperative planning and to prevent misunderstanding of the arrangement of the abdominal viscera. This facilitated the surgical team's adaptation to the mirror image of the standard procedure and helped avoid intraoperative complications due to cardiovascular and hepatobiliary malformations associated with SIT. Pancreaticoduodenectomy in patients with SIT can be performed successfully with detailed preoperative assessment, use of effective techniques by the surgeon, and appropriate support by assistants.

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Citations

Jul 6, 2014·Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen·R Kasperk
Mar 20, 2015·Gastroenterology Research and Practice·Renping HuangYinghui Guan
Aug 31, 2019·BMJ Case Reports·Venkata Vishwanath Reddych, Anand Prakash
Feb 23, 2020·Anatomical Science International·Hirokazu NaritaHiroshi Shimoda
Aug 25, 2019·Veterinary Sciences·Reynaldo Oliva HernándezHoang-Thanh Le
May 29, 2021·Curēus·Abdulwahab HamidSaad Rashid Mohammad Al Kaabi

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Methods Mentioned

BETA
X-ray
SMA
imaging techniques

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