Pancreatic adenocarcinoma in a patient with situs inversus: a case report of this rare coincidence

Abstract

Background: Situs inversus (SI) is a relatively rare occurrence in patients with pancreatic adenocarcinoma. Pancreatic resection in these patients has rarely been described. CT scan imaging is a principle modality for detecting pancreatic cancer and its use in SI patients is seldom reported.

Case presentation: We report a 48 year old woman with SI who, despite normal CT scan 8 months earlier, presented with obstructive jaundice and a pancreatic head mass requiring a pancreaticoduodenectomy. The surgical pathology report demonstrated pancreatic adenocarcinoma.

Conclusion: SI is a rare condition with concurrent pancreatic cancer being even rarer. Despite the rarity, pancreaticoduodenectomy in these patients for resectable lesions is safe as long as special consideration to the anatomy is taken. Additionally, radiographic imaging has significantly improved detection of early pancreatic cancer; however, there continues to be a need for improved detection of small neoplasms.

Figure 1

Diagnostic CT scan. CT scan obtained 8 months later when the patient presented with jaundice and a bulging Ampulla of Vater on ERCP. A new 4.2 cm mass is now present in the pancreatic head, obstructing the common bile duct.

Figure 2

Pre-diagnosis CT scan. Consecutive CT scan slices demonstrate SI and mild atrophy of the pancreatic head but no mass present 8 months prior to her diagnosis of pancreatic cancer. The CT scan was obtained to evaluate abdominal pain.

Figure 3

Intra-operative photograph prior to reconstruction. Abdominal contents noted to be inverted. Liver positioned in the right upper quadrant. Prolene stay sutures mark the cut edge of the pancreas. Bulldog clamp is occluding the common hepatic duct. Superior mesenteric vein and portal vein oriented to the patient's left.