Mirror image hepatectomy in a patient with situs inversus totalis

Hideaki Uchiyama, Ken Shirabe, Tomoharu Yoshizumi, Toru Ikegami, Yuji Soejima, Tetsuo Ikeda, Hirofumi Kawanaka, Yo-Ichi Yamashita, Masaru Morita, Eiji Oki, Koushi Mimori, Keishi Sugimachi, Hiroshi Saeki, Masayuki Watanabe, Kenji Takenaka, Yoshihiko Maehara
Fukuoka Igaku Zasshi, Hukuoka Acta Medica 2013, 104 (11): 430-4

BACKGROUND: Hepatectomy in a patient with situs inversus patient is technically challenging because of its complete mirror image anatomy, especially for a tumor located deep in the liver. Incorrectly identifying intrahepatic vessels and biliary system would lead to serious complications. We experienced a hepatectomy for a tumor in a patient with situs inversus totalis with referring to computer-generated mirror images.

METHODS: A 66-year-old female patient with situs inversus totalis was diagnosed with hepatocellular carcinoma, 5 cm in diameter, centrally located just above the hepatic hilum compressing the right and left hepatic duct. The liver infected with hepatitis C was cirrhotic with a moderate amount of ascites. We preoperatively created several diagrams of the mirror image anatomy and made plans for how to resect this tumor, presupposing the patient had an ordinary anatomy. The tumor was successfully enucleated with referring to these diagrams.

RESULTS: The operation time was 454 minutes. Five units of fresh frozen plasma was transfused intraoperatively. Although she suffered refractory ascites which needed repeated paracentesis, she managed to leave the hospital two months after the operation.

CONCLUSION: Creating a mirror image anatomy enables surgeons to safely perform a complex hepatectomy in a patient with situs inversus totalis.


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