Situs Inversus Totalis

There are certain conditions that you read about in medical school, think how interesting that it must be, and never expect to see it in real life.

** WARNING: GRAPHIC IMAGES **

A middle aged woman came to the hospital with abdominal pain and vomiting. After a day of non-operative management, I realized her bowel obstruction was not going to improve unless I took her to the operating room and surgically fixed whatever was causing the blockage. Once I opened her abdomen, I found multiple rope-like bands or scar tissue, splayed out like a spider-web down into the pelvis. I cut through each one, freeing the bowel and relieving the obstruction. After cutting the adhesions, I wanted to look at the entire length of the bowel to make sure that I hadn’t missed any other points of obstruction. I tried to start with the cecum in the right lower quadrant, but it seemed to be held with scar tissue into the left lower quadrant. Not wanting to cause injury, I decided to start with a constant, the rectum. To my surprise, instead of the sigmoid colon sweeping down from the left into the pelvis to form the rectum, it was coming down from the right-side. I followed the entire colon to find the cecum and its connection with the small intestines were on the left. In fact, as I inspected the entire abdomen, the liver and gallbladder with on the left, the stomach was situated on the right and her great vessels were swapped in their location. Upon further investigation, I found her heart happily pumping in its home in the right chest. My patient has a condition called Situs Inversus and Dextrocardia. Her internal organs are the mirror image of what is the norm. Dextrocardia means the heart is on the right side.

If she had not developed a bowel obstruction, we might have never have know just how special she was on the inside. She is a 1 in 10,000. She recovered well from the surgery and smiled when I told her God had made her extra special inside.

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