Duodenal Intussusception in an Adult With Situs Inversus Totalis

Abstract

Situs inversus totalis (SIT) is a rare congenital abnormality in which there is a mirror image of all thoracic and abdominal organs. Most individuals have no specific health issues. Their unique anatomy can pose challenges when they present to the emergency department with vague symptoms. The condition has been known to be associated with multiple anomalies, including Kartagener syndrome, congenital heart defects, asplenia, gastroschisis, and duodenal atresia, to name a few. However, it is rarely associated with intestinal obstruction. Duodenal intussusception occurs when a portion of the intestine telescopes into another portion of the duodenum and rarely occurs in adults. Here, we present a rare case of a 50-year-old female who presented to the emergency department with complaints of epigastric and left upper quadrant abdominal pain. Following thorough clinical and radiological evaluation, she was discovered to have SIT with evidence of duodenal intussusception. The patient was ultimately transferred to a tertiary center for evaluation by general surgery and gastroenterology and discharged for outpatient follow-up. To the best of our knowledge, this is the first reported case in the literature.

Keywords: dextrocardia; duodenojejunal intussusception; intussusception; situs inversus; situs-inversus-totalis.

Figure 1. Normal sinus rhythm with occasional premature atrial complexes

Figure 2. Chest X-ray demonstrating dextrocardia consistent with SIT. Note: The gastric bubble is located in the right upper quadrant of the abdomen as opposed to the left upper quadrant

SIT: situs inversus totalis

Figure 3. Coronal view of CT abdomen and pelvis with contrast consistent with SIT. The white arrow indicates duodenal intussusception. Note: The liver is located in the left upper quadrant

SIT: situs inversus totalis