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

• Published in: Surgery today (Tokyo, Japan) Vol. 40; no. 1; pp. 79 - 82
• Main Authors: Maruyama, Yuichiro, Horiuchi, Hiroyuki, Okabe, Yoshinobu, Kawahara, Ryuichi, Uchida, Shinji, Sakai, Takenori, Hisaka, Toru, Ishikawa, Hiroto, Mikagi, Kazuhiro, Yoshitomi, Munehiro, Kawashima, Yusuke, Fujishita, Manami, Akasu, Gen, Katsumoto, Mitsuru, Eto, Daimei, Ureshino, Mitsutoshi, Goto, Yuichi, Ureshino, Hiroki, Kinoshita, Hisafumi
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 2010
• Subjects: Adenocarcinoma - complications; Adenocarcinoma - surgery; Aged; Case Report; Humans; Lymph Node Excision; Male; Medicine; Medicine & Public Health; Middle Aged; Pancreatectomy - methods; Pancreatic Neoplasms - complications; Pancreatic Neoplasms - surgery; Pancreaticoduodenectomy - methods; Perioperative Care; Situs Inversus - complications; Surgery; Surgical Oncology; Tomography, X-Ray Computed; Distal pancreatectomy; Pancreaticoduodenectomy; Situs inversus totalis; Pancreatic cancer
• ISSN: 0941-1291; 1436-2813
• DOI: 10.1007/s00595-009-4064-z

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.