Dec. 10 2013
Situs Inversus
Stevenson, R. E. (2006). Human Malformations and Related Anomalies, (pp.185-189). New York:
Oxford University Press
This source, a book, was written by Dr. Roger Stevenson who is currently a senior clinical
geneticist at the Greenwood Genetics centre in Greenwood, South Carolina. This source identifies situs
inversus as being the complete mirror image reversal of the asymmetric organs in the human body.
Most parts of the body are symmetrical on the sagittal plane, but some organs are asymmetric. When
the asymmetric organs are mirrored compared to their usual positions, the arrangement is called situs
inversus. It is explained how situs inverus may be the name incorrectly given to another condition
called polyasplenia, which is the presence of multiple spleens. However, these conditions sometimes
exist together. It is also worth noting that the name situs inversus is often reserved for cases where all
asymetric organs are mirrored. When not completely mirrored, the term situs ambiguus is often used.
Yaghan, R. J., Gharaibeh, K. I., and Hammori, S. (2001). Feasibility of Laparoscopic
Cholecystectomy in Situs Inversus. Journal of Laparoendoscopic & Advanced Surgical
Techniques, 11(4): 233-237. doi:10.1089/109264201750539763.
This source is a case report of the removal of gallbladder stomes from two patients with situs
inversus. Two of the three authors of this source held the qualification of the fellowship of the royal
college of surgeons and the third held a doctorate of medicine at the time of writing this case report.
This case report details the ways in which the surgical method had to be modified to accomdate for the
situs inversus of the patients.This case report emphasisies the surgical implications of operating on a
patient with situs inversus. Because of the reversed organs, the surgeon must stand on the opposite side
of the patient, and the endoscopic video monitor is placed over the opposite shoulder of the patient.
There is no protocol for the rearrangement of abdominal ports to accomodate a surgeon on the opposite
side of the patient. The surgeon must either use his left hand to preform much of the operation or cross
his hands, resulting in awkward posture and the surgeon's elbows bumping into medical instruments.
This source also identifies situs inversus as an autosomal recessive genetic condition that occurs in
1:5000 to 1:10000 of all hospital admissions.
Colomb, K., Mizrahi, S., Downes, T., Hayes, D.H., Hussey, J.L., and Boudreaux, J.P. (1993). Liver
transplantation in patients with situs inversus. Transplant International, 6(3):158-160.
All authors of this source are board certified surgeons. Their surgical specialities are general
surgery, with the exception of Dr. Boudreaux who is a board certified critical care surgeon. Some of
authors continue to practice medicine and some of the authors are retired. This source details a
seemingly impossible medical procedure, a liver transplantation in patients with situs inversus. It would
be expected that patients with such unique anatomy would be ineligible for liver transplantation. This
source documents the vascular anomalies that are associated with situs inversus. Many different grafts
of extended length are needed to position the donor liver in place. Illiac arterial and venous grafts are
often needed to ensure that the donor liver can be placed well. Partial liver transplant can be useful for
situs inversus patients because of the liver's ability to grow and fill the mirrored cavity.
Blegen, H. M. (1949). Surgery in Situs Inversus. Annals of Surgery, February; 129(2): 244–259.
H.M. Blegen, M.D.'s many papers were on the forfront of modern medicine as it was in the
1940's and 1950's. His work provides a basis from which further reseach and development was made.
This source is the oldest of all, and was the first paper of its kind addressing the topic of surgery in
patients with situs inversus. Most of the other sources have this source listed as one of their references.
This source starts with a history of the ailment with references all the way back to Aristotle, who first
noticed the ailment in animals. This source documents 159 cases of patients with situs inversus who
underwent a wide range of surgical procedures. The operations documented were 99 appendectomies,
24 operations for gall bladder disease, five stomach operations, eight pelvic laporotomies, two
nepheropexies, 11 operations of the large and small bowel, one repair of rectovesitcal fistula and nine
thoracic operations.