Pancreaticoduodenectomy for common bile duct cancer in a patient with situs inversus totalis: a case report

We describe the first case of successfully performed pancreaticoduodenectomy to treat common bile duct cancer in a patient with situs inversus totalis. A 65-year-old man was admitted to our hospital with the working diagnosis of obstructive jaundice. He had a history of cholecystectomy, and situs inversus totalis had been diagnosed at that time in another hospital. Preoperative work-ups with ultrasonography, computed tomography, and percutaneous cholangiography were followed by drainage lead to the diagnosis of common hepatic artery arising from the superior mesenteric artery. He underwent curative pancreaticoduodenectomy without complications. The postoperative course was uneventful, and he was discharged on postoperative day 29. He is doing well, with no evidence of recurrence 40 months after surgery. Deliberately performed preoperative imaging studies, especially selective angiography, were essential for the surgical resection of bile duct cancer in this patient with situs inversus totalis.