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When hepatoma rupture happens in situs inversus totalis: side matters
Insights
This case report details a fatal outcome in a patient with situs inversus totalis due to undiagnosed hepatomas and coronary artery disease. Early recognition of situs anomalies is crucial for accurate diagnosis and management.
Area of Science:
- Medicine
- Cardiology
- Gastroenterology
Background:
- Situs inversus totalis is a rare congenital condition with mirrored organ placement.
- Altered anatomy in situs inversus totalis can complicate disease diagnosis and management.
- Coronary artery disease and hepatomas are significant health concerns.
Observation:
- A 73-year-old male with unrecognized situs inversus totalis presented with left upper quadrant pain.
- The patient was diagnosed with acute myocardial infarction and underwent coronary angioplasty.
- Massive bleeding from previously undetected hepatomas led to hypovolemic shock and death.
Findings:
- The patient had coexisting coronary artery disease and ruptured hepatomas.
- This combination in situs inversus totalis is, to our knowledge, unprecedented.
- Undiagnosed hepatomas caused fatal hypovolemic shock post-angioplasty.
Implications:
- Timely recognition of situs anomalies is critical to prevent misdiagnosis and inappropriate treatment.
- Altered anatomy necessitates careful consideration during diagnostic and therapeutic procedures.
- This case highlights the importance of a thorough diagnostic approach in patients with rare congenital anomalies.
Abstract:
The authors reported a 73-year-old alcoholic man with previously-unrecognized situs inversus totalis suffering from left upper quadrant pain. Acute myocardial infarction was diagnosed and coronary angioplasty was performed immediately. However, the massive bleeding from the previously-unfound hepatomas caused hypovolemic shock and fatal outcome. Situs inversus totalis is a rare congenital anomaly with a complete mirror image of the thoracic and abdominal organs. Although being considered a benign entity, it would disturb diagnosis-making of the visceral diseases owing to the altered anatomy. To our knowledge, the coexistence of the coronary artery disease and ruptured hepatomas in situs inversus totalis, as in our patient, is never described. Recognition of any situs anomalies in time is the key to avoid misdiagnosis, inappropriate managements, and unwanted consequences.
