Whipple procedure for ampulla of Vater cancer in a patient with situs inversus (clinical case)

A clinical case of a rare combination of complete transposition of internal organs (situs inversus totalis) with adenocarcinoma of the major duodenal papilla is presented. In addition to situs vicserum inversus, the patient has a special variant of vascular anatomy that is not included in the generally accepted classification of variants of arterial liver anatomy according to Michaels N.A. (1955), namely: separate separation of the left and right hepatic arteries from the ventral trunk. After individual preoperative planning, a patient with a complete reverse position of the abdominal organs and non-standard vascular anatomy was performed Whipple procedure. Non-invasive CT angiography is important in a complex preoperative examination, which allows timely identification and clarification of frequently occurring features of blood supply to the hepatopancreatoduodenal zone in patients with situs inversus totalis. Such surgical interventions should be performed in large multi-specialty medical centers that have extensive experience in performing pancreatoduodenal resections.

1. Patle N.M., Tantia O., Sasmal P.K., Khanna S., Sen B. Laparoscopic cholecystectomy in situs inversus – our experience of 6 cases. Indian J. Surg. 2010; 72 (5): 391–394. https://doi.org/10.1007/s12262-010-0159-4

2. Tsunoda S., Miyashita T., Murata M. Pancreaticoduodenectomy for common bile duct cancer in a patient with situs inversus totalis: a case report. Int. Surg. 2006; 91 (1): 24–27. https://doi.org/10.1186/1756-0500-5-681

3. Balakhnin P.V., Tarazov P.G. Anatomical classification of arterial blood supply to the liver for radio-endovascular procedures: analysis of 3756 hepatic angiographies. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2014; 19 (2): 24–41 (In Russian)

4. Mohandas S., Dickson-Low R., Karanjia N. Intraductal papillary mucinous neoplasm (IPMN) of the pancreas with situs inversus totalis – case report with review of literature. J. Gastrointest. Cancer. 2011; 43 (1): 136–138. https://doi.org/10.1007/s12029-011-9352-3

5. Peeters H., Devriendt K. Human laterality disorders. Eur. J. Med. Genet. 2006; 49 (5): 349–362. https://doi.org/10.1016/j.ejmg.2005.12.003

6. Zheng Z., Xiao Y., Zhang S., Pu G. A patient with situs inversus totalis and pancreatic head cancer. Dig. Liv. Dis. 2013; 45 (9): 11. https://doi.org/10.1016/j.dld.2013.02.003

7. Sakaguchi O., Kamio H., Sakurai H., Kumagai K., Kobayashi E., Kakita N., Tsuchidate M., Sakai K. Pancreas head carcinoma associated with situs inversus viscerum totalis. Nihon Geka Gakkai Zasshi. 1985; 86 (1): 111–115.

8. Organ B.C., Skandalakis L.J., Gray S.W., Skandalakis J.E. Cancer of bile duct with situs inversus. Arch. Surg. 1991; 126 (9): 1150–1153.

9. Bilimoria M.M., Parsons W.G., Small W.Jr., Talamonti M.S. Pancreaticoduodenectomy in a patient with ampullary carcinoma and situs inversus. Surgery. 2001; 130 (3): 521–524.

10. Macafee D.A., Armstrong D., Hall R.I., Dhingsa R., Zaitoun A.M., Lobo D.N. Pancreaticoduodenectomy with a “twist”: the challenges of pancreatic resection in the presence of situs inversus totalis and situs ambiguus. Eur. J. Surg. Oncol. 2007; 33 (4): 524–527.

11. Sceusi E.L., Wray C.J. Pancreatic adenocarcinoma in a patient with situs inversus: a case report of this rare coincidence. World J. Surg. Oncol. 2009; 18 (7): 98. https://doi.org/10.1186/1477-7819-7-98

12. Maruyama Y., Horiuchi H., Okabe Y., Kawahara R., Uchida S., Sakai T., Hisaka T., Ishikawa H., Mikagi K., Yoshitomi M., Kawashima Y., Fujishita M., Akasu G., Katsumoto M., Eto D., Ureshino M., Goto Y., Ureshino H., Kinoshita H. Perioperative challenges associated with a pancreaticoduodenectomy and distal pancreatectomy for pancreatic cancer in patients with situs inversus totalis: report of two cases. Surg. Today. 2010; 40 (1): 79–82. https://doi.org/10.1007/s00595-009-4064-z

13. Benhammane H., Kharmoum S., Terraz S., Berney T., NguyenTang T., Genevay M., El Mesbahi O., Roth A. Common bile duct adenocarcinoma in a patient with situs inversus totalis: report of a rare case. BMC Res. Notes. 2012; 12 (5): 681. https://doi.org/10.1186/1756-0500-5-681.

14. Kyuno D., Kimura Y., Imamura M., Uchiyama M., Ishii M., Meguro M., Kawamoto M., Mizuguchi T., Hirata K. Pancreaticoduodenectomy for biliary tract carcinoma with situs inversus totalis: difficulties and technical notes based on two cases. World J. Surg. Oncol. 2013; 17 (11): 312. https://doi.org/10.1186/1477-7819-11-312

15. Chen C., Yi X., He Y., Cai S., Gu G., Sun C., Lai J., Ma Y. Pancreatic head cancer involving variant common hepatic artery with situs inversus totalis. ANZ J. Surg. 2018; 88 (5): 506–508. https://doi.org/10.1111/ans.13431

16. Guo C.X., Chen W., Yao W.Y., Li G.G., Zhang Q., Chen Y.W., Pan Y., Shen Y.N., Liang T.B., Bai X.L. The first report of laparoscopic pancreaticoduodenectomy for primary duodenal carcinoma in a patient with situs inversus totalis: report of a rarecase. Surg. Laparosc. Endosc. Percutan Tech. 2019; 29 (3): 29–33. https://doi.org/10.1097/SLE.0000000000000659

17. Lim H.K., Choi Y.S., Lee S.E., Kang H. Pancreaticoduodenectomy performed in a patient with situs ambiguous accompanied with isolated levocardia, malrotation, and normal spleen. Ann. Surg. Treat. Res. 2014; 87 (6): 340–344. https://doi.org/10.4174/astr.2014.87.6.340

18. Ogawa A., Hayakawa N., Yamamoto H., Maki А., Mori N., Kanazawa H., Hibi S., Nimura Y., Nagino M., Sakamoto E. Carcinoma of the head of the pancreas with complete situs inversus and polycystic liver: case report. J. Hep. Bil. Pancr. Surg. 1995; 2: 90–94. https://doi.org/10.1007/BF02348295

19. Khatsiev B., Baichorov E., Kuzminov A. Pancreatic adenocarcinoma in a pregnant patient with situs inversus: a case report. Internat. J. Biomed. 2014; 4 (2): 107–108.