PMC4746979_01
Computed tomography images
JMAS-12-68-g001.jpg
PMC4746979_01_JMAS-12-68-g001.jpg
F1
The computed tomography findings of the anatomical variation had revealed a complete mirror image pattern of the viscera and vasculature in the abdomen and thorax [Figure 1].
Phase 1 of mobilization of esophagus with lymph nodes clearance
JMAS-12-68-g002.jpg
PMC4746979_01_JMAS-12-68-g002.jpg
F2
The azygos vein was isolated skeletonised and divided in between sutures [Figure 2]. Infracarinal dissection [Figure 2] was commenced with en bloc clearance of the carinal group of lymph node and further dissection in the plane just posterior to the pericardium until the OG junction. Lymph nodes in the left parathracheal and along the lateral reticular nucleus were cleared [Figure 2]. The aortopulmonary window was cleared of the lymph nodes and inferior dissection along the right side of the esophagus continued clearing the paraesophageal group of nodes on the right until the OG junction [Figure 2].
Phase 2 of gastric mobilization and conduit formation
JMAS-12-68-g003.jpg
PMC4746979_01_JMAS-12-68-g003.jpg
F3
The patient was turned over to the supine position and ports were placed in an appropriate comparative configuration to the ports placed in the patient without situs inversus and were found to have mirror image of the normal anatomy [Figure 3]. The tissue in the posterior aspect of the stomach up to the crus is cleared with a completely mobilized stomach from the hiatus to the pylorus [Figure 3].