Prophylactic laparoscopic total gastrectomy in a patient with situs inversus totalis

Abstract

A rare case was demonstrated whereby a prophylactic laparoscopic total gastrectomy was performed in a 29-year-old male with a CDH1 gene mutation in the context of rare anatomical anomaly, situs inversus totalis (SIT). This report provides radiological and laparoscopic images detailing the patient's unique anatomy. We also describe the operative approach and technical challenges whilst accounting for the patient's anatomical anomaly. This is the first known case of a laparoscopic total gastrectomy for a CDH1 gene mutation in a patient with SIT. With sufficient pre-operative evaluation and meticulous intra-operative caution, this technically complex operation is safe and feasible in patients with mirror-image anatomy as seen in SIT.

Keywords: gastrectomy; situs inversus.

Figure 1

Coronal cross-section image of computed tomography scan.

Figure 2

Abdominal port placement

Figure 3

Series of intra-operative images: (A) major abdominal structures noted on opposite sides, in keeping with situs inversus totalis, (B) left gastric artery demonstrated coursing to the patient’s right side, (C) transected pylorus course from the patient’s right side, (D) alimentary limb shown after completion of oesophago-jejunal anastomosis.