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Pancreatic adenocarcinoma in a patient with situs inversus: a case report of this rare coincidence.

Sceusi EL, Wray CJ - World J Surg Oncol (2009)

Bottom Line: SI is a rare condition with concurrent pancreatic cancer being even rarer.Despite the rarity, pancreaticoduodenectomy in these patients for resectable lesions is safe as long as special consideration to the anatomy is taken.Additionally, radiographic imaging has significantly improved detection of early pancreatic cancer; however, there continues to be a need for improved detection of small neoplasms.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, University of Texas Medical School at Houston, Houston, Texas, USA. eric.l.sceusi@uth.tmc.edu

ABSTRACT

Background: Situs inversus (SI) is a relatively rare occurrence in patients with pancreatic adenocarcinoma. Pancreatic resection in these patients has rarely been described. CT scan imaging is a principle modality for detecting pancreatic cancer and its use in SI patients is seldom reported.

Case presentation: We report a 48 year old woman with SI who, despite normal CT scan 8 months earlier, presented with obstructive jaundice and a pancreatic head mass requiring a pancreaticoduodenectomy. The surgical pathology report demonstrated pancreatic adenocarcinoma.

Conclusion: SI is a rare condition with concurrent pancreatic cancer being even rarer. Despite the rarity, pancreaticoduodenectomy in these patients for resectable lesions is safe as long as special consideration to the anatomy is taken. Additionally, radiographic imaging has significantly improved detection of early pancreatic cancer; however, there continues to be a need for improved detection of small neoplasms.

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Related in: MedlinePlus

Intra-operative photograph prior to reconstruction. Abdominal contents noted to be inverted. Liver positioned in the right upper quadrant. Prolene stay sutures mark the cut edge of the pancreas. Bulldog clamp is occluding the common hepatic duct. Superior mesenteric vein and portal vein oriented to the patient's left.
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Figure 3: Intra-operative photograph prior to reconstruction. Abdominal contents noted to be inverted. Liver positioned in the right upper quadrant. Prolene stay sutures mark the cut edge of the pancreas. Bulldog clamp is occluding the common hepatic duct. Superior mesenteric vein and portal vein oriented to the patient's left.

Mentions: Interventional radiology was able to perform a percutaneous transhepatic cholangiogram and place an external biliary catheter to decompress her biliary system. The patient subsequently underwent a pancreaticoduodenotomy and pathology showed moderately differentiated pancreatic ductal adenocarcinoma T3, N0, Mx (American Joint Committee on Cancer Stage IIa) (Figure 3). Follow-up CT scan 5 months post-operatively showed no evidence of recurrent cancer.


Pancreatic adenocarcinoma in a patient with situs inversus: a case report of this rare coincidence.

Sceusi EL, Wray CJ - World J Surg Oncol (2009)

Intra-operative photograph prior to reconstruction. Abdominal contents noted to be inverted. Liver positioned in the right upper quadrant. Prolene stay sutures mark the cut edge of the pancreas. Bulldog clamp is occluding the common hepatic duct. Superior mesenteric vein and portal vein oriented to the patient's left.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2803176&req=5

Figure 3: Intra-operative photograph prior to reconstruction. Abdominal contents noted to be inverted. Liver positioned in the right upper quadrant. Prolene stay sutures mark the cut edge of the pancreas. Bulldog clamp is occluding the common hepatic duct. Superior mesenteric vein and portal vein oriented to the patient's left.
Mentions: Interventional radiology was able to perform a percutaneous transhepatic cholangiogram and place an external biliary catheter to decompress her biliary system. The patient subsequently underwent a pancreaticoduodenotomy and pathology showed moderately differentiated pancreatic ductal adenocarcinoma T3, N0, Mx (American Joint Committee on Cancer Stage IIa) (Figure 3). Follow-up CT scan 5 months post-operatively showed no evidence of recurrent cancer.

Bottom Line: SI is a rare condition with concurrent pancreatic cancer being even rarer.Despite the rarity, pancreaticoduodenectomy in these patients for resectable lesions is safe as long as special consideration to the anatomy is taken.Additionally, radiographic imaging has significantly improved detection of early pancreatic cancer; however, there continues to be a need for improved detection of small neoplasms.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, University of Texas Medical School at Houston, Houston, Texas, USA. eric.l.sceusi@uth.tmc.edu

ABSTRACT

Background: Situs inversus (SI) is a relatively rare occurrence in patients with pancreatic adenocarcinoma. Pancreatic resection in these patients has rarely been described. CT scan imaging is a principle modality for detecting pancreatic cancer and its use in SI patients is seldom reported.

Case presentation: We report a 48 year old woman with SI who, despite normal CT scan 8 months earlier, presented with obstructive jaundice and a pancreatic head mass requiring a pancreaticoduodenectomy. The surgical pathology report demonstrated pancreatic adenocarcinoma.

Conclusion: SI is a rare condition with concurrent pancreatic cancer being even rarer. Despite the rarity, pancreaticoduodenectomy in these patients for resectable lesions is safe as long as special consideration to the anatomy is taken. Additionally, radiographic imaging has significantly improved detection of early pancreatic cancer; however, there continues to be a need for improved detection of small neoplasms.

Show MeSH
Related in: MedlinePlus