Percutaneous Endoscopic Gastrostomy Tube Insertion in Patient With Situs Inversus Totalis

Abstract

Situs inversus totalis (SIT) is a rare congenital condition in which the abdominal and thoracic organs are completely reversed from right to left, and their diagnosis is usually incidental. However, patients with SIT need a comprehensive radiological evaluation before undertaking any invasive procedures. Percutaneous endoscopic gastrostomy (PEG) insertion is an effective procedure for enteral feeding in patients with difficulty swallowing. Many post-procedural complications have been reported after the PEG procedure. We performed PEG insertion in an 85-year-old Qatari SIT patient, who was admitted to the hospital as a case of aspiration pneumonia and on nasogastric feeding tube (NGT). The procedure was started while the patient was in left lateral decubitus position as in normal anatomy patients after careful examination and in accordance with the general principles of PEG insertion. No complications were seen, neither intraoperative nor postoperative in two months follow-up. We suggest that in a patient with SIT, PEG insertion can be performed while the patient is in left decubitus position with no additional risk or extra intraoperative time if the pre-operative anatomical position of vital organs is carefully evaluated.

Keywords: endoscopic; gastrostomy; inversus; situs; totalis.

Figure 1. Coronal CT scan abdomen of a patient with SIT

Arrow pointed to the liver, located on the left side in a patient with SIT. SIT, Situs inversus totalis.

Figure 2. The inner part of PEG fixed in the stomach

Arrow pointed to the internal part of PEG. PEG, Percutaneous endoscopic gastrostomy.