Our Summary

Situs inversus totalis (SIT) is a rare condition where a person’s internal organs are located in a mirror image of their usual position. This paper looks at a case where a 79-year-old woman with SIT, who also had a significant colon cancer, underwent a specific type of laparoscopic surgery.

This surgery is challenging for even experienced surgeons due to the unusual organ positioning. In this case, the surgeons used a technique known as splenic flexure mobilization (SFM) during the surgery. They found it was crucial to use CT angiography to understand the patient’s unique anatomy, use a mirrored video of a “normal” version of the surgery to help guide the procedure, and add an additional access point (epigastric trocar) to make the procedure safer and more comfortable.

The surgery was successful, with no complications, and the patient was healthy and cancer-free 30 months later.

FAQs

  1. What is Situs inversus totalis (SIT) and how does it affect surgery?
  2. What technique did the surgeons use to assist in the sigmoidectomy of the patient with SIT?
  3. What measures were taken to ensure the safety and success of the surgery given the patient’s unique anatomy?

Doctor’s Tip

A helpful tip a doctor might give a patient about sigmoidectomy is to make sure to follow all pre-operative instructions provided by your healthcare team, such as fasting before surgery and taking any prescribed medications. Additionally, it is important to discuss any concerns or questions you may have with your surgeon before the procedure. After surgery, following post-operative care instructions, such as taking prescribed medications, attending follow-up appointments, and gradually resuming normal activities, will help ensure a smooth recovery process.

Suitable For

Patients who are typically recommended sigmoidectomy include those with:

  1. Colon cancer: Sigmoidectomy is commonly performed to treat colon cancer, especially if the cancer is located in the sigmoid colon.

  2. Diverticulitis: Sigmoidectomy may be recommended for patients with recurring or severe diverticulitis, which is inflammation or infection of small pouches in the colon.

  3. Colonic polyps: Sigmoidectomy may be recommended for patients with large or precancerous polyps in the sigmoid colon.

  4. Inflammatory bowel disease (IBD): Sigmoidectomy may be recommended for patients with severe ulcerative colitis or Crohn’s disease affecting the sigmoid colon.

  5. Bowel obstruction: Sigmoidectomy may be recommended for patients with a blockage in the sigmoid colon that cannot be relieved by other treatments.

  6. Volvulus: Sigmoidectomy may be recommended for patients with sigmoid volvulus, which is a twisting of the sigmoid colon that can lead to bowel obstruction.

  7. Chronic constipation: Sigmoidectomy may be recommended for patients with severe chronic constipation that does not respond to other treatments.

Overall, sigmoidectomy is a surgical procedure that may be recommended for a variety of conditions affecting the sigmoid colon, and it is important for patients to discuss their individual case with a healthcare provider to determine if sigmoidectomy is the best treatment option for them.

Timeline

Before the sigmoidectomy:

  • The patient is diagnosed with colon cancer and undergoes various tests to determine the extent of the cancer.
  • The patient is informed about the need for surgery to remove the affected part of the colon.
  • The patient undergoes pre-operative preparations, which may include fasting, bowel preparation, and discussion of risks and benefits of the surgery.
  • The patient undergoes the sigmoidectomy surgery, in this case using the SFM technique due to the patient’s SIT condition.
  • The surgery is successful, and the patient is monitored closely for any complications in the immediate post-operative period.
  • The patient is discharged from the hospital and continues to recover at home, following post-operative care instructions.

After the sigmoidectomy:

  • The patient has regular follow-up appointments with their healthcare provider to monitor their recovery and check for any signs of cancer recurrence.
  • The patient may undergo further treatments such as chemotherapy or radiation therapy, depending on the stage and type of cancer.
  • The patient gradually resumes normal activities and adjusts to any changes in bowel function after the surgery.
  • The patient continues to have regular screenings for colon cancer to monitor for any signs of recurrence.
  • The patient remains cancer-free and healthy, with no complications from the surgery, 30 months after the sigmoidectomy.

What to Ask Your Doctor

  1. What is a sigmoidectomy and why is it necessary for my condition?
  2. How will my unique anatomy, specifically with Situs inversus totalis, affect the surgery?
  3. What is splenic flexure mobilization (SFM) and why is it being used in my surgery?
  4. How will CT angiography help in understanding my anatomy and guiding the surgery?
  5. What are the potential risks and complications associated with this surgery, especially considering my condition?
  6. How long is the recovery period expected to be and what can I do to aid in my recovery?
  7. Will I need any further treatment or monitoring after the surgery?
  8. How successful is this type of surgery in treating colon cancer, particularly in patients with unusual anatomy like mine?
  9. Are there any alternative treatment options that I should consider?
  10. What is the long-term prognosis for someone with my condition undergoing this surgery?

Reference

Authors: Kudo T, Matsuda T, Urakawa N, Hasegawa H, Kanaji S, Yamashita K, Oshikiri T, Kakeji Y. Journal: Asian J Endosc Surg. 2022 Jan;15(1):168-171. doi: 10.1111/ases.12944. Epub 2021 Apr 23. PMID: 33893717