Situs inversus totalis with malignant lymphoma of the stomach: report of a case

• Published in: Surgery today (Tokyo, Japan) Japan), 2003-01, Vol.33 (7), p.533-536
• Main Authors: Murakami, Saburo, Terakado, Masahiro, Misumi, Misono, Tsuji, Yoshitaka, Okubo, Katsuhiko, Hirayama, Renzo, Inoue, Kaiji, Arai, Eiichi
• Format: Article
• Language: English
• Subjects: Combined Modality Therapy; Female; Humans; Imaging, Three-Dimensional; Lymphoma, B-Cell - complications; Lymphoma, B-Cell - surgery; Lymphoma, B-Cell - therapy; Lymphoma, Large B-Cell, Diffuse - complications; Lymphoma, Large B-Cell, Diffuse - surgery; Lymphoma, Large B-Cell, Diffuse - therapy; Middle Aged; Situs Inversus - complications; Stomach Neoplasms - complications; Stomach Neoplasms - surgery; Stomach Neoplasms - therapy; Tomography, X-Ray Computed
• ISSN: 0941-1291; 1436-2813
• DOI: 10.1007/s10595-002-2530-z

Situs inversus totalis is a rare congenital anomaly that often occurs concomitantly with other disorders. We report a case of situs inversus totalis with malignant lymphoma of the stomach, which was successfully treated by surgery followed by chemotherapy and irradiation. The patient was a 51-year-old woman who present with colicky pain in the left upper quadrant of her abdomen. Chest X-ray showed a right-sided heart, and ultrasonography and computed tomography (CT) of the abdomen showed a situs inversus totalis with multiple gallstones in the gallbladder. Tree-dimensional reconstructed CT of the abdomen showed no other malformations coexisting with situs inversus totalis, but a barium upper gastrointestinal series found an inverted stomach and an elevated tumor with ulceration in the center, localized in the antrum of the stomach. First, we performed a cholecystectomy, followed by a total gastrectomy with dissection of the lymph nodes and splenectomy, and Roux-en-Y reconstruction. Histopathological examination confirmed a diagnosis of malignant lymphoma of the stomach (diffuse large B-cell type) with metastasis to the regional lymph nodes. Chemotherapy using the CHOP regimen was given three times, starting 1 month postoperatively. A followup CT scan showed enlargement of one lymph node around the abdominal aorta and irradiation was delivered to the area of the inverted Y in the abdomen. At the time of writing, 10 months after surgery, the patient is well with no signs of recurrence and leading a normal life. Careful preoperative assessment is very important for determining the most appropriate surgical procedure in patients with situs inversus totalis associated with a malignancy.