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Case Reports
. 2021 Sep 6;13(9):e17764.
doi: 10.7759/cureus.17764. eCollection 2021 Sep.

Situs Inversus Totalis in Association With Duodenal Atresia

Murtadha A Alshaikh  1 , Hussain A Al Ghadeer  1 , Hamed Alabad  2 , Madinah Almohsin  3 , Roqaia A Al Ali  4
Affiliations
Case Reports

Situs Inversus Totalis in Association With Duodenal Atresia

Murtadha A Alshaikh et al. Cureus. .

Abstract

Situs inversus totalis is the mirror image transposition of the abdominal-thoracic viscera. Approximately one in every 5,000 to 20,000 live births has situs inversus totalis. Most commonly, it is found incidentally and is asymptomatic. A number of malformations, including cardiac, splenic, and gastrointestinal, have been associated with this condition. Coexistence with duodenal atresia is extremely rare, reported in fewer than 30 cases worldwide and one case in Saudi Arabia. We report a preterm neonate who presented with bilious vomiting. Diagnosis of situs inversus totalis with duodenal atresia type III was established and other anomalies were ruled out. The patient was managed surgically by duodenal-duodenostomy and Ladd's procedure. The report emphasizes the importance of identifying this condition and recognizing the "mirror anatomy" before carrying out an operation. Once the diagnosis is confirmed, surgical intervention must be performed as soon as possible to prevent complications.

Keywords: duodenal atresia; duodenostomy; malrotation; situs inversus totalis; situs inversus with dextrocardia.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Plain X-ray of chest and abdomen revealing right-sided cardiac shadow, NGT in the stomach with double bubble sign on the right side, and hepatic shadow on the left side. A temperature probe on the right side of the abdomen was used as a site marker.
NGT, frequent nasogastric tube.
Figure 2
Figure 2. A picture during laparotomy showed type III duodenal atresia complete obstruction at the end of the second part of the duodenum.
D1: first part of duodenum; D2: second part of duodenum; J: jejunum.
Figure 3
Figure 3. Abdomen postoperative X-ray showed megaduodenum and pneumoperitoneum.
Figure 4
Figure 4. Two weeks postoperative upper GI contrast study showed no leakage from anastomosis area with megaduodenum.
GI, gastrointestinal.
See this image and copyright information in PMC

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