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1.
Retroversus Implantation of a Liver Graft: A Novel Approach to the Deceased Donor with Situs Inversus Totalis 总被引:1,自引:0,他引:1
J. J. Pomposelli M. A. DaCosta K. McPartland R. L. Jenkins 《American journal of transplantation》2007,7(7):1869-1871
Situs inversus totalis is a rare anatomical abnormality that results in dextrocardia, mirror image of normal abdominal organs and other congenital abnormalities. Deceased donors with this condition are often declined on anatomic concerns. While there have been numerous reports of successful liver transplantation in recipients with situs inversus, review of the world's literature provided only three case reports using deceased donors with situs inversus. In this report, a novel approach to implantation of a liver graft from a donor with situs inversus is presented. To avoid possible torsion and blockage of venous outflow, a modified retroversus piggyback technique with 180 degrees ventral caudal (backwards) rotation of the liver graft along the axis of the vena cava was performed. This orientation resulted in the retro hepatic vena cava facing anteriorly and the larger anatomic liver lobe in the right upper quadrant. Excellent outcome was achieved without technical difficulty. Retroversus implantation of a liver graft from a donor with situs inversus is safe and effective and associated with favorable outcome. 相似文献
2.
Keith Colomb Solly Mizrahi Thomas Downes Daniel H. Hayes John L. Hussey J. Philip Boudreaux 《Transplant international》1993,6(3):158-160
Situs inversus has been considered an absolute contraindication to liver transplantation due to technical difficulties. Associated vascular malformation and distorted anatomy may make the procedure even more complicated or impossible. Only three cases of patients with abdominal situs inversus who underwent successful liver transplantation have been reported in the English literature. We describe two additional patients with situs inversus who suffered from biliary atresia and underwent successful liver transplantation. The preoperative evaluation and the operative procedure are presented, and technical difficulties are discussed. Since biliary atresia is associated with polysplenia syndrome, including vascular malformation and visceral malposition, we suggest that each case be extensively evaluated preoperatively to determine the size requirement for the donor liver and the feasibility of reconstruction. 相似文献
3.
Kamei H Kasahara M Uryuhara K Kozaki K Ogawa K Ogura Y Fujimoto Y Takada Y Tanaka K 《Journal of pediatric surgery》2005,40(3):E35-E37
Two cases of living-donor liver transplantation performed in patients with situs inversus are reported. The authors discuss the operative management for a situs inversus recipient to undergo liver transplantation. 相似文献
4.
S. C. Rayhill D. Scott S. Orloff J.-L. Horn J. Schwartz A. Zaman A. Sasaki W. S. Naugler M. Chang J. Gaumond Y. Wu J. Ham 《American journal of transplantation》2009,9(7):1602-1606
Situs inversus totalis is a rare congenital anomaly in which the heart and abdominal organs are oriented in a mirror image of normal. It provides a unique challenge as there is no established technique for liver transplantation in these patients. Employing two major alterations from our standard technique, a liver was transplanted in the left subphrenic space of a patient with situs inversus totalis . First, the liver was flipped 180° from right to left (facing backward). Second, a reversed cavaplasty (anterior, not posterior, donor suprahepatic caval incision) was performed. Otherwise, it was standard, with end-to-end anastomoses of the portal vein, hepatic artery and bile duct. Three years after the entirely uneventful transplant, the recipient continues to enjoy the benefits of a normally functioning liver. The described technique prevented torsion, kinking and tension on the anastomosed structures by allowing the liver to sit naturally in an anatomical position in the left hepatic fossa. As it required no special measurements or maneuvers, the technique was easy to execute and required no donor liver size restrictions. This novel technique, with a reversed cavaplasty and a 180° right-to-left flip of the liver into a left-sided hepatic fossa, may be ideal for situs inversus totalis . 相似文献
5.
Lee HH Lee DS Yoo KE Lee KW Kim SJ Joh JW Seo JM Choe YH Lee SK 《Transplantation proceedings》2004,36(8):2282-2283
Until recently, situs inversus was considered to be an absolute contraindication for liver transplantation. However, recent reports have suggested that situs inversus should not be considered a contraindication. This study presents a successful living donor liver transplantation performed in a 4-month-old male infant with biliary atresia and situs inversus. The surgical findings revealed abdominal situs inversus with polysplenia and an absent retrohepatic inferior vena cava and intestinal malrotation. 相似文献
6.
Anatomic anomalies may present technical difficulties during orthotopic liver transplantation. Abdominal situs inversus was considered a contraindication to liver transplantation. A successful liver transplant in a patient with both situs inversus and dextrocardia is described, along with a technical review. 相似文献
7.
Murakami S Terakado M Misumi M Tsuji Y Okubo K Hirayama R Inoue K Arai E 《Surgery today》2003,33(7):533-536
Situs inversus totalis is a rare congenital anomaly that often occurs concomitantly with other disorders. We report a case
of situs inversus totalis with malignant lymphoma of the stomach, which was successfully treated by surgery followed by chemotherapy
and irradiation. The patient was a 51-year-old woman who present with colicky pain in the left upper quadrant of her abdomen.
Chest X-ray showed a right-sided heart, and ultrasonography and computed tomography (CT) of the abdomen showed a situs inversus
totalis with multiple gallstones in the gallbladder. Tree-dimensional reconstructed CT of the abdomen showed no other malformations
coexisting with situs inversus totalis, but a barium upper gastrointestinal series found an inverted stomach and an elevated
tumor with ulceration in the center, localized in the antrum of the stomach. First, we performed a cholecystectomy, followed
by a total gastrectomy with dissection of the lymph nodes and splenectomy, and Roux-en-Y reconstruction. Histopathological
examination confirmed a diagnosis of malignant lymphoma of the stomach (diffuse large B-cell type) with metastasis to the
regional lymph nodes. Chemotherapy using the CHOP regimen was given three times, starting 1 month postoperatively. A follow-up
CT scan showed enlargement of one lymph node around the abdominal aorta and irradiation was delivered to the area of the inverted
Y in the abdomen. At the time of writing, 10 months after surgery, the patient is well with no signs of recurrence and leading
a normal life. Careful preoperative assessment is very important for determining the most appropriate surgical procedure in
patients with situs inversus totalis associated with a malignancy.
Received: April 25, 2002 / Accepted: November 19, 2002
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ID="*" Reprint requests to: S. Murakami 相似文献
8.
Evaluation, operative management, and outcome after liver transplantation in children with biliary atresia and situs inversus. 总被引:2,自引:0,他引:2
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D G Farmer A Shaked K M Olthoff D K Imagawa J M Millis R W Busuttil 《Annals of surgery》1995,222(1):47-50
INTRODUCTION: Biliary atresia, a common indication for liver transplantation, can be associated with situs inversus. Our experience with liver transplantation in children (n = 6) was reviewed retrospectively. PATIENTS AND METHODS: Preoperative duplex sonography, computerized tomography, and visceral angiography were obtained. Vascular anomalies identified included preduodenal portal vein (6/6), interrupted inferior vena cava (5/6), and aberrant hepatic artery (4/6). RESULTS: The liver graft was placed in a midline position. Venous continuity was achieved by donor suprahepatic inferior vena cava to recipient hepatic cloaca and direct end-to-end portal anastomosis. The donor infrahepatic inferior vena cava was oversewn. Arterial continuity was restored using either a direct branch-patch anastomosis (3/6) or a supraceliac aortic interposition graft (3/6). In retrospect, preoperative diagnostic work-up was noncontributory and outcome was not complicated by pre-existing situs inversus. CONCLUSION: Situs inversus in liver recipients requires operative technical modifications, but does not change outcome. Furthermore, extensive preoperative work-up should be avoided. 相似文献
9.
Wente MN Thorn M Radeleff B Dei-Anane G Mehrabi A Sauer P Büchler MW Schmidt J Kraus TW Schemmer P 《Clinical transplantation》2006,20(2):151-155
Liver transplantation (LT) in an adult with situs inversus (SI) is extremely rare and requires precise pre-operative management. A 48-yr-old male with SI suffering from alcoholic liver cirrhosis underwent LT at our institution in March 2003. Pre-operatively, liver anatomy was determined by CT scan, three-dimensional liver reconstruction and angiography. LT was performed using the Belghiti technique with side-to-side cavo-caval anastomosis, transplanting a graft from a donor with normal anatomy. Post-operatively, the patient recovered without major complications, except an epileptic event because of a central pontine myelinolysis, and he was discharged on the 25th post-operative day. Three months after surgery, the T-drain placed intra-operatively into the donor bile duct was removed; transplant perfusion and function were stable with an actual follow-up period of 24 months. LT in patients with SI is feasible. Pre-operative imaging with three-dimensional reconstruction is a beneficial tool for operation planning in patients with rare anatomic variations. 相似文献
10.
Asensio Llorente M López Espinosa JA Ortega López J Sánchez Sánchez LM Castilla Valdez MP Ferrer Blanco C Margarit Creixell C Iglesias Berengue J 《Cirugía pediátrica : organo oficial de la Sociedad Espa?ola de Cirugía Pediátrica》2003,16(1):44-47
Biliary atresia is the most common indication for liver transplantation in the pediatric age group. The Kasai portoenterostomy has become established as the primary treatment for biliary atresia. If portoenterostomy fails, death before 2 years of age is likely without liver transplantation. The most common multiple malformation syndrome associated with biliary atresia is polysplenia syndrome, which forms a constellation of defects of body symmetry, splenic development and vascular anomalies, including situs inversus, polysplenia and others. The situs inversus was formerly considered an absolute contraindication for liver transplantation. Recently however, several case reports have been published suggesting that neither situs inversus nor this particular subset of vascular abnormalities should be considered contraindications to liver transplantation. We present one case of liver transplantation performed in patient with biliary atresia, situs inversus and polysplenia. This is the first report described in Spain for a liver transplant in a child with biliary atresia plus situs inversus. 相似文献
11.
Sunao Uemura Hiromichi Maeda Masaya Munekage Ryuji Yoshioka Takehiro Okabayashi Kazuhiro Hanazaki 《Journal of gastrointestinal surgery》2009,13(9):1724-1727
Background Situs inversus totalis is a rare condition characterized by a mirror-image transposition of the abdominal and thoracic viscera.
In order to develop safe techniques for hepatic resection, it is important to report surgical outcomes in cases complicated
by situs inversus totalis and other anomalies.
Case The patient was a 64-year-old man with situs inversus totalis who had previously undergone sigmoidectomy with regional lymphadenectomy
for sigmoid colon cancer at age 62. Despite postoperative adjuvant chemotherapy, tumor markers increased and multiple liver
metastases were detected on abdominal ultrasonography. Enhanced computed tomography revealed not only liver metastases but
also hepatobiliary anomalies associated with situs inversus totalis as follows: (1) portal vein located anterior to the common
bile duct or hepatic artery, (2) proper hepatic artery arising from the superior mesenteric artery, (3) “left” (right in normal
population)-sided umbilical portion of the portal vein and total ramification of intrahepatic portal branches from that point,
(4) hepatic vein directly communicating to the “left” atrium. For the treatment of hepatic metastases from sigmoid colon cancer
in a patient with situs inversus totalis, “left” hepatic lobectomy, partial hepatectomy, and radiofrequency ablation therapy
were performed. The postoperative course was uneventful. Adjuvant chemotherapy has been continued for 2 years after the second
operation and the patient is doing well without recurrence.
Conclusion Since situs inversus totalis is occasionally accompanied by multiple hepatobiliary anomalies, careful evaluation of the related
anatomy using modern imaging modalities is crucial for safe hepatic resection. 相似文献
12.
Pascal A. Berdat Paul Mohacsi Ulrich Althaus Thierry Carrel 《European journal of cardio-thoracic surgery》1998,14(6):258-634
Heart transplantation represents a valuable therapeutical option for patients with congenital heart disease and end-stage heart failure. We report the case of a young adult patient with a situs inversus and additional complex congenital malformations of the heart who underwent several prior palliative interventions, a biventricular repair being impossible. Orthotopic cardiac transplantation with several technical modifications was performed successfully at the age of 19 years. 相似文献
13.
ERCP and laparoscopic cholecystectomy for cholangitis in a 66-year-old male with situs inversus 总被引:2,自引:0,他引:2
A case report of the successful management of a patient with situs inversus viscerum and symptomatic choledocholithiasis and cholangitis is presented. The preoperative evaluation of the choledochus via ERCP and successful common bile duct stone extraction enabled successful laparoscopic cholecystectomy. The anatomic challenge of situs inversus viscerum mandates the selective use of intraoperative cholangiography during and upon completion of the laparoscopic cholecystectomy. 相似文献
14.
目的:探讨全内脏转位并胆囊结石患者施行腹腔镜胆囊切除术(laparoscop ic cholecystectomy,LC)的可行性及手术方法。方法:对1992年10月~2006年10月施行的8 256例LC中遇到的4例全内脏转位患者的临床资料进行回顾性总结。结果:4例全内脏转位患者均采用3孔法完成LC术,无中转开腹,全组患者术后均未放置腹腔引流管,恢复良好。结论:全内脏转位合并胆囊结石或胆囊息肉患者行LC是安全可行的,可与常规LC取得同样满意的临床效果。 相似文献
15.
Peter Lemke Ali Civelek Roland Brandt Matthias Roth 《European journal of cardio-thoracic surgery》2003,23(6):1071-1073
We report an unusual case of accessory mitral valve tissue associated with a situs inversus and missing obstruction of the left ventricular outflow tract. To our knowledge our patient is the only elderly patient with an accessory mitral valve with associated situs inversus undergoing surgical resection. The report emphasizes direct cardioscopy through the aortic annulus allowing precise excision of the abnormal tissue. 相似文献
16.
完全性胸腹腔内脏反位合并十二指肠壶腹周围癌一例报告与文献复习 总被引:3,自引:0,他引:3
目的总结完全性胸腹腔内脏反位合并十二指肠壶腹周围癌的临床诊治方法。方法报道2006年3月收治的1例极为罕见的完全性胸腹腔内脏反位合并十二指肠壶腹周围癌行胰十二指肠切除术的病例,并复习国内外相关文献。结果本例患者病理诊断为十二指肠乳头及壶腹部腺癌Ⅰ-Ⅱ级。术后1周胆红素降至正常;但2周后出现胃-空肠吻合输出袢粘连性不完全性梗阻,经内镜下置管、鼻饲、营养支持、针灸等处理,40d后痊愈出院。经检索,全球自1936-2006年间报道的全胸腹腔内脏反位合并恶性肿瘤的患者仅15例;其中只有5例全胸腹腔内脏反位合并胰头与壶腹周围癌的报道。结论完全性胸腹腔内脏反位合并肿瘤时,若无明显禁忌证,应同样予以积极的外科治疗,术中操作应注意完全相反的解剖学结构。 相似文献
17.
Toshiyuki Kuwata Tetsuji Kawata Takashi Ueda Hidehito Sakaguchi Shigeo Nagasaka Shigeki Taniguchi 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2004,52(10):473-475
Dextrocardia associated with situs inversus totalis is a rare condition. A 49-year-old man with dextro-cardia and situs inversus
totalis underwent off-pump quintuple coronary artery bypass grafting using bilateral internal thoracic arteries and bilateral
radial arteries. The operative technique was similar to that of off-pump coronary artery bypass grafting for situs solitus.
His postoperative recovery was uneventful. 相似文献
18.
Helga Meisel Petra Preikschat Petra Reinke Berthold Hocher Klemens Budde W.O. Bechstein Peter Neuhaus D.H. Krüger H.H. Neumayer 《Transplant international》1999,12(4):283-287
Hepatitis B virus (HBV) core deletion variants with enhanced viral replication are associated with rapid deterioration of
liver function in renal allograft recipients. Antiviral agents such as famciclovir and lamivudine offer new treatment strategies
for these patients. Appearance, accumulation and persistence of HBV core deletion mutants were closely monitored in a kidney
transplant recipient with liver cirrhosis before and after initiation of antiviral treatment. Under treatment with famciclovir
HBV DNA concentration decreased by 50 %, HBV mutants persisted. After replacement of famciclovir by lamivudine HBV replication
was reduced below the detection limit. Lamivudine was well tolerated and liver function improved. After successful combined
kidney/liver transplantation the patient became HBsAg and HBV DNA (detected by PCR) negative under continuous hyperimmune
globulin and lamivudine treatment. Antiviral therapy with lamivudine may be useful in treatment of progressive liver disease
associated with HBV core deletion mutants in renal allograft recipients and may enable successful liver transplantation.
Received: 12 June 1998 Received after revision: 16 October 1998 Accepted: 10 November 1998 相似文献
19.
Laparoscopic appendectomy in a female patient with situs inversus: case report and literature review. 总被引:1,自引:0,他引:1
Jonathan Y Song Nasir Rana Carlos A Rotman 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2004,8(2):175-177
BACKGROUND: Situs inversus is an uncommon condition caused by a single autosomal recessive gene of incomplete penetration. A potential diagnostic dilemma can occur in the young female patient with a history of situs inversus who presents with pelvic pain. METHODS: A 32-year-old multiparous patient with a known history of situs inversus presented with complaints of pelvic pain. A medical history and full physical examination were indicative of possible endometriosis. RESULTS: The patient underwent an operative laparoscopy, which revealed stage II pelvic endometriosis based on the American Fertility Society Revised Classification for Endometriosis (R-AFS), with appendicular and periappendicular adhesions involving the cecum. Ablation of endometriosis and an appendectomy were performed. CONCLUSION: The authors believe the laparoscopic approach to an appendectomy is ideal in a patient with situs inversus and should be performed at the time of laparoscopy performed for another reason. 相似文献
20.
Ashwanth Reddy Surendran Paramasivam Naveen Alexander Abhilash Vigneshwar Ravisankar Manoj Thillai 《International journal of surgery case reports》2014,5(11):821-823