Total Gastrectomy for Gastric Carcinoma with Situs Inversus Totalis
Bayamurat Damai*, Bumchin Byambadorj, Erkhembayar Enkhbat, Jargalsaikhan Duntee, Khaliunaa Battulga, Baatarkhuyag Ochgerel, Chinzorig Munkhjargal, Ganbaatar Rentsenbalbar
ABSTRACT
Background: Situs inversus totalis (SIT) is a rare congenital condition characterized by a complete mirror-image transposition of the thoracic and abdominal organs. The coexistence of gastric cancer in patients with SIT is extremely uncommon and presents unique diagnostic and surgical challenges due to altered anatomy.
Case Presentation: We report the case of a 53-year-old male who presented with epigastric pain radiating to the right costal margin and back, poor digestion, anorexia, constipation, fatigue, and weight loss. Upper gastrointestinal endoscopy performed one year prior revealed a gastric ulcer, which was treated medically. Due to worsening symptoms, repeat endoscopy demonstrated an ulcerative lesion on the lesser curvature of the gastric antrum, and biopsy confirmed moderately differentiated adenocarcinoma. Contrast-enhanced abdominal computed tomography revealed situs inversus totalis without associated vascular or visceral anomalies. The patient underwent gastrectomy with D2 lymphadenectomy. The procedure was completed successfully without major intraoperative complications, despite the mirror-image anatomy.
Discussion: Surgical management of gastric cancer in patients with SIT is technically demanding and requires thorough preoperative evaluation and detailed anatomical understanding. Although some authors recommend altering the positions of the surgical team, the operation in this case was performed using standard positioning with careful intraoperative adaptation. No abnormal vascularization or additional malformations were encountered.
Conclusion: Gastric cancer associated with situs inversus totalis is rare. With meticulous preoperative imaging, comprehensive anatomical knowledge, and careful surgical technique, gastrectomy with D2 lymphadenectomy can be performed safely and effectively in patients with SIT. Awareness of potential associated anomalies is essential to minimize perioperative risks.
