TRANSHIATAL DISTAL ESOPHAGECTOMY AND TOTAL GASTRECTOMY IN A CASE OF ESOPHAGOGASTRIC TUMOUR WITH SITUS INVERSUS TOTALIS

Abstract

Situs inversus totalis (SIT) is a rare congenital anomaly with a thoracic cavity, and abdominal structures are reversed. The most suitable approach and surgical technique in a patient with SIT and organ variation remain unclear. We report our experience with a case of situs inversus totalis diagnosed with the esophagogastric tumour. We report a 77 years old female diagnosed with locally advanced esophagogastric tumour classified as Siewert Type II. Preoperative CT scan shows a complete mirror image of the thoracic cavity and abdominal viscera and no vascular anomalies. She underwent distal esophagectomy and total gastrectomy with Roux-en-y anastomosis and D2 lymph node dissection.  Distal esophagectomy was done via transhiatal approach for adequate proximal margin resection. There were no intra-operative problems, and the postoperative course was uneventful. Till present, we believe that this is the first case of Transhiatal distal esophagectomy and total gastrectomy in situs inversus totalis patient reported in Malaysia.