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case_images: Comprehensive radiological and intraoperative visualization in Situs Inversus Totalis (SIT) accompanied by gastric cancer. (A) Chest X-ray demonstrates dextrocardia and mirror-image arrangement of the thoracic structures. (B) Axial computed tomography (CT) scan reveals a gastric lesion located in the body of the stomach. (C) Coronal CT image shows the gastric lesion in the body of the stomach. (D) Sagittal CT image further delineates the gastric lesion in the stomach body. (E) Three-dimensional vascular reconstruction depicts major vessels such as the celiac trunk and Superior Mesenteric Artery (SMA). (F) The surgical field following distal gastrectomy and D2 lymph node dissection, detailing the altered anatomy and resected regions. (G) The gastrojejunostomy utilizing a linear cutter stapler. (H) The Braun anastomosis. LGA, Left Gastric Artery; PGA, Post Gastric Artery; SA, Splenic Artery; CHA, Common Hepatic Artery; PHA, Proper Hepatic Artery; SMA, Superior Mesenteric Artery.
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case_images: Chest X-ray revealed dextrocardia with mirror-image branching of the great vessels ( Figure 1A ). Tomography (CT) imaging confirmed gastric cancer with SIT ( Figures 1B-D ). To better understand the aberrant vascular distribution in the abdomen and aid in meticulous surgical planning, a three-dimensional reconstruction of the abdominal vessels was completed. No anomalies were detected apart from the mirroring inherent to SIT ( Figure 1E ). The patient underwent distal gastrectomy with D2 lymph node dissection under general anesthesia, followed by Billroth II and Braun anastomoses ( Figures 1F-H ).
case_images: Literature review flowchart.
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case_images: Figure 2 ). From the years 2000 to 2023, we retrieved a total of 132 records.
case_images: Overview of SIT coexistent with gastric cancer cases and treatment outcomes based on different surgical approaches. (A) Geographic distribution of reported cases of SIT combined with gastric cancer. (B) Surgical duration associated with different operative procedures in the treatment of patients with SIT coexistent with gastric cancer. (C) Estimated blood loss during various surgical procedures for patients with SIT combined with gastric cancer. (D) Length of hospital stay following different surgical procedures for SIT patients combined with gastric cancer.
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case_images: The geographical distribution showed one patient from Morocco, one from India, one from Turkey, one from Australia, eleven from China, nine from Korea, and twenty-five from Japan ( Figure 3A ). ESD, laparoscopic surgery, robotic surgery, and open abdomen procedures were 55min (15-95min), 275min (117-446min), 291min (180-451min), and 252min (95-375min), respectively ( Figure 3B ). Estimated blood loss was minimal in ESD, while laparoscopic surgery averaged 66ml (0-350mL), robotic surgery 43ml (0-150ml), and open abdomen procedures 210ml (100-380ml) ( Figure 3C ). Patients undergoing ESD stayed an average of 6.00 days, which was significantly shorter when compared to 9.84 days for laparoscopic surgery, 10.36 days for robotic surgery, and 14.00 days for open surgery ( Figure 3D ).
case_images: Vascular anomalies associated with surgical intervention in patients with Situs Inversus Totalis (SIT) coexistent with gastric cancer. (A) No vascular anomaly observed in the patient. (B) Patient with Common Hepatic Artery (CHA) originating from the Superior Mesenteric Artery (SMA). (C) Patient with Right Hepatic Artery (RHA) originating from the SMA and Accessory Left Hepatic Artery (ALHA) deriving from the Left Gastric Artery (LGA). (D) Patient with CHA originating from SMA and ALHA arising from LGA. (E) Patient with Left Hepatic Artery (LHA) branching from the SMA.
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case_images: Out of the 49 patients we reviewed, 10 reported vascular variations, offering valuable data to better comprehend the possible vascular anomalies in such rare cases ( Figure 4 ). Among these 10 patients, four observed that the common hepatic artery (CHA) branched from the superior mesenteric artery (SMA)( Figure 4B ). Two patients had an unusual vascular presentation where the right hepatic artery (RHA) originated from the SMA, and the left hepatic lobe was supplied by the ALHA originating from the Left Gastric Artery (LGA)( Figure 4C ). Artery (LGA)( Figure 4D ). Another patient presented a variant where the left hepatic artery branched from the superior mesenteric artery ( Figure 4E ).