PMC6000729_01
CT scan of the abdomen in our situs inversus totalis (SIT) patient showing the spleen (S) located on the right side, the liver and gallbladder (GB) on the left side.
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Our patient is a 43 year old female with known pre-operative diagnosis of situs inversus without Kartagener's syndrome that was demonstrated on a prior CT of the abdomen and pelvis (Fig. 1).
CXR in our SIT patient demonstrating dextrocardia *.
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Her dextrocardia was discovered in the past on a chest x-ray (CXR) obtained during a work up for atrial fibrillation (Fig. 2).
The gallbladder (GB) is located in the left upper quadrant, and the pylorus (P) in the midline at the level of the falciform ligament.
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Upon entering the abdominal cavity, general inspection confirmed the totally reversed anatomy (Fig. 3) with the gallbladder located on the left side of the abdominal cavity, the spleen, angle of His and the greater curvature of the stomach on the right side.
Represent the actual anatomy in our patient and the relationship of ligament of Treitz (LT) relative to the falciform ligament (both in midline position), and the corresponding orientation of the Roux limb, the bilio-pancreatic limb and the jejuno-jejunal anastomosis.
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To ascertain that no twisting of the small bowel mesentery was created, the LT, BP limb and JJ anastomosis were placed on one side; which in this case was just at or slightly to the left of the falciform ligament, and the Roux limb was positioned opposite to these structures and to the right of the falciform ligament (Fig. 4).