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Indian Journal of Clinical Anatomy and Physiology

Embryological and clinical significance of situs inversus totalis: Rare case presenting with cholelithiasis and choledocholithesasis

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Article Type : Case Report

Author Details: William*,S K Goyal

Volume : 6

Issue : 3

Online ISSN : 2394-2126

Print ISSN : 2394-2118

Article First Page : 373

Article End Page : 375


Situs inversus is a rare, autosomal recessive condition that is incidentally discovered. It may occur with
dextrocardia, levocardia, or situs ambiguous, the latter with either right or left isomerism, along with
asplenia or polysplenia. Incidence of situs inversus varies from 0.002% to 1%. Mostly it occurs in males. 1–3
Situs inversus totalis is the mirror image of the situs solitus, which describe the normal position of the
thoracic and abdominal viscera. It may be associated with other genetic diseases such as Kartagener’s
syndrome. 4 This condition does not affect the life expectancy or quality of life. 1,3 Individuals with situs
inversus anomaly exhibit a variety of associated gastrointestinal abnormalities. These anomalies involve
liver, biliary tract, stomach, spleen and the intestines. There are few cases in which the anomaly was
never detected during lifetime because of the absence of any presenting symptom. Such anomalies may be
incidental findings during autopsies or cadaveric dissections. Any mechanical disturbance which occurs in
any of the two rotational movements may give rise to abnormal positioning of the heart or dextrocardia.
Some researchers defined a gut rotationdetermining factor which is usually located in the left side of the
body. 5 The transposition of the abdominal viscera in the present case may be related to malrotation of the
gastrointestinal system during the embryonic development. It has been thought that the disturbance of this
gut rotation determining factor during ontogenesis may be solely responsible for situs inversus. 5
Aristotle discovered this alternation in animals while in humans it was described by Fabricius in1600.
Vehemeyer first identified situs inverses in 1967 with x-rays. 4,6 First case of SIT was by Venu et al
(1985) 3in America and latest by Kamani L et al (2014) 7 in Pakistan. The exact etiologies remains obscure
but attempts have been made to explain it on the basis of a complex gene with variable expression. 6 More
than one genetic mutation was implicated in etiopathogenesis. 8
Mohamed S et al 2013 reported a male case of situs inversus which remained undiagnosed until the age of
50 years. He presented as chest pain and collapsed even before starting treatment and was diagnosed SITS
on autopsy. 9
Clinical manifestation depends on the location of the compromised organ. It does demand greater attention
from surgeons and endoscopist because diagnosis can be c.

Keywords: Situs inversus totalis (sit), Bile duct stone, Gut rotation. Choledocholithiasis, ERCP, Situs inversus.

Doi :-https://doi.org/10.18231/j.ijcap.2019.081