PMC5651547_01
Chest radiography and abdominal computed tomography of the patient. (A) Chest radiography showing dextrocardia. (B) Abdominal computed tomography (CT) shows a mass in the ascending colon (arrow).
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Chest radiography showed dextrocardia (Fig. 1A).
CT angiography and CT colonography. (A) Three-dimensional CT angiography shows the superior mesenteric artery, located on the right side (arrow). (B) CT-colonography shows a mass in the ascending colon.
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A ). CT angiography showed that the superior mesenteric artery was located on the left side (Fig. 2B). An ulcerated lesion in the ascending colon was observed by colonoscopy (Fig. 3).
Colonoscopy revealing an ulcerated lesion in the ascending colon (arrow).
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A ). CT angiography showed that the superior mesenteric artery was located on the left side (Fig. 2B). An ulcerated lesion in the ascending colon was observed by colonoscopy (Fig. 3).
Location of surgeons and trocar placement in this patient with situs inversus totalis.
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The operating surgeon was situated on the right side of the patient (opposite to the usual for surgery), with the first assistant on the left, and the endoscopist on the right (Fig. 4). For the operating surgeon, a 12-mm trocar was placed in the right lower quadrant and a 5-mm trocar was placed in the right flank, and for the assistant, a 12-mm trocar was placed in the left lower quadrant and a 5-mm trocar was placed in the left flank (Fig. 4).
Intraoperative findings. (A)Right lobe of the liver and gallbladder are located in left upper quadrant. (B) The ascending colon is located on the left side. (C) The ileocolic vessels are identified (arrow). (D) The ileocolic vessels (arrow) and superior mesenteric vein (arrowhead) are identified.
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The tumor was located in the ascending colon (Fig. 5A, B). The ileocolic vessels were identified and divided after the superior mesenteric vein was exposed (Fig. 5C, D).