Mirror Image Hepatectomy in a Patient with Situs Inversus Totalis

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  • Uchiyama Hideaki
    Department of Surgery, Fukuoka City Hospital
  • Shirabe Ken
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Yoshizumi Tomoharu
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Ikegami Toru
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Soejima Yuji
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Ikeda Tetsuo
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Kawanaka Hirofumi
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Yamashita Yoichi
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Morita Masaru
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Oki Eiji
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Mimori Koshi
    Department of Surgery, Kyushu University Beppu Hospital
  • Sugimachi Keishi
    Department of Surgery, Kyushu University Beppu Hospital
  • Saeki Hiroshi
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Watanabe Masayuki
    Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University
  • Takenaka Kenji
    Department of Surgery, Fukuoka City Hospital
  • Maehara Yoshihiko
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University

Bibliographic Information

Other Title
  • 鏡面画像を利用した完全内臓逆位患者に対する肝切除の1例
  • Case Report : Mirror Image Hepatectomy in a Patient with Situs Inversus Totalis

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Abstract

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.

Journal

  • 福岡醫學雜誌

    福岡醫學雜誌 104 (11), 430-434, 2013-11-25

    Fukuoka Medical Association

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