Partial situs inversus: Duodenal obstruction in a neonate with isolated levocardia

doi:10.1016/0022-3468(92)90517-B

Journal of Pediatric Surgery

Volume 27, Issue 12, December 1992, Pages 1584-1586

https://doi.org/10.1016/0022-3468(92)90517-B Get rights and content

Abstract

An unusual case of duodenal obstruction in an infant with isolated laevocardia is described. The following anatomic features were shown preoperatively: (1) duodenal obstruction; (2) right-sided stomach and spleen; (3) left-sided liver; (4) totally right-sided located colon in mirror image nonrotation; and (5) levocardia without any defect for dysfunction. The mentioned findings were verified intraoperatively and the cause of the duodenal obstruction was found to be an aberrant vessel. This case is a rare one regarding the lack of heart and spleen defects and the cause of duodenal obstruction. It also demonstrates the necessity of meticulous investigation and precise description of the anomaly and suggests individualization as far as the management of these cases is concerned.

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Cited by (15)

A colovesical fistula with a persistent descending mesocolon due to partial situs inversus: A case report
2017, International Journal of Surgery Case Reports
Citation Excerpt :
In the partial type, there may be only thoracic inversion, cardiac chamber reversal, or only abdominal organ inversion accompanied by syndromes showing splenic anomalies, an annular pancreas, a horseshoe kidney, a diaphragmatic hernia, or other developmental abnormalities [7]. The partial situs inversus described was probably caused by a reversal of location in terms of right and left, of the duodenum, pancreas, liver, stomach, and spleen, due to a possible abnormality in rotation in early embryonic life [9]. In the present case, a CT revealed inversus of the intra-abdominal organs, viz., the stomach, spleen, and pancreas with the descending colon transferred to the middle of the pelvis.
Situs inversus viscerum, a congenital condition in which the visceral organs are a mirror image of their normal physiological positions, could be total or partial. Persistent descending mesocolon (PDM) is a congenital anomaly that is asymptomatic because of its short length. PDM causing intestinal obstruction is a known clinical complication.
A 74-year-old woman presented with pneumaturia and enteruria for two months, and recurrent cystitis for a month. An enhanced computed tomography (CT) showed air in the bladder along with sigmoid colonic diverticula adherent to it, suspecting a fistula. The CT also showed partial situs inversus with the common hepatic artery, and left colic artery arising abnormally from the superior mesenteric artery (SMA). Minimally invasive endoscopic closure using the over-the-scope clipping system was difficult because of thickening and scar tissue due to chronic inflammation from diverticulitis. Thus, a sigmoidectomy was performed to close the fistula. Intraoperatively, we noted an abnormally fixed descending mesocolon. An emergency reoperation was performed on the sixth postoperative day owing to an anastomotic leak. Suture failure was attributed to these congenital abnormalities due to insufficient blood flow from an absent marginal vessel and a high endocolonic pressure by adhesions. Sigmoid colon re-resection and maturation of an ileostomy was performed. The patient had no specific postoperative complications, and the ileostomy was closed after three months.
We report an extremely rare case of colovesical fistula due to a PDM in a patient having partial situs inversus with abnormal branches originating from the SMA.
Neonatal intestinal obstruction with isolated levocardia
2000, Journal of Pediatric Surgery
Citation Excerpt :
Anomalies of gut fixation and rotation are common and can be explained on embryological basis.2 The associated duodenal obstruction can be caused by peritoneal bands, intraluminal web, or rarely aberrent vessel crossing the duodenum.2,5 In the current case the duodenal obstruction was caused by peritoneal bands.
An unusual case of isolated levocardia, duodenal obstruction, and malrotation with volvulus is reported. Three cases of situs inversus abdominus with malrotation with volvulus have been reported to date. The current case is the fourth case and only the second survivor in the series. In cases of situs inversus abdominus, because of inversion of viscera, the volvulus may occur in an anticlockwise direction and, thus, should be derotated in a clockwise direction. J Pediatr Surg 35:1115-1116. Copyright © 2000 by W.B. Saunders Company.
Isolated levocardia-a rare fetal anomaly with successful pregnancy outcome
2019, Indian Journal of Obstetrics and Gynecology Research
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2013, Pediatric Cardiology
Combination of partial situs inversus, polysplenia and annular pancreas with duodenal obstruction and intestinal malrotation
2012, JBR-BTR
Situs inversus abdominalis and duodenal atresia: A case report and review of the literature
2009, South African Journal of Surgery

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Partial situs inversus: Duodenal obstruction in a neonate with isolated levocardia

Abstract

Malpositions of the heart

Dextrocardia, mesocardia and laevocardia: The segmental approach to diagnosis in congenital heart disease

Isolated laevocardia; Two cases with abdominal situs in-versus, thoracic situs solitus and normal circulation

Am Heart J

Laevocardia with transposition of the abdominal viscera

Br Heart J

Body assymetry and splenic anomalies

Situs inversus: The complex inducing neonatal intestinal obstruction

J Pediatr Surg