Perioperative challenges associated with a pancreaticoduodenectomy and distal pancreatectomy for pancreatic cancer in patients with situs inversus totalis: report of two cases

Yuichiro Maruyama, Hiroyuki Horiuchi, Yoshinobu Okabe, Ryuichi Kawahara, Shinji Uchida, Takenori Sakai, Toru Hisaka, Hiroto Ishikawa, Kazuhiro Mikagi, Munehiro Yoshitomi, Yusuke Kawashima, Manami Fujishita, Gen Akasu, Mitsuru Katsumoto, Daimei Eto, Mitsutoshi Ureshino, Yuichi Goto, Hiroki Ureshino, Hisafumi Kinoshita
Surgery Today 2010, 40 (1): 79-82
Situs inversus totalis is a rare anatomic variant of a complete mirror-image transposition of the thoracic and abdominal viscera. The performance of a pancreaticoduodenectomy and distal pancreatectomy in patients with situs inversus totalis is both rare and challenging. We herein present two cases of pancreatic cancer with situs inversus totalis. The abdominal anatomy was preoperatively assessed by multidetectorrow computed tomography, three-dimensional reconstruction, and angiography. We herein report that a pancreaticoduodenectomy and distal pancreatectomy with standard regional lymphadenectomy are feasible in patients with situs inversus totalis. Due to the transposition of the viscera and major blood vessels in such cases, preoperative knowledge of the exact anatomy, mapping of anomalies, and meticulous forward planning are essential for performing these technically difficult and complex hepatobiliary-pancreatic surgeries.

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