Journal of Postgraduate Medicine
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Year : 1985  |  Volume : 31  |  Issue : 3  |  Page : 175-6  

Hypertrophic ileo-caecal tuberculosis with complete situs inversus (a case report).

AC Pinto, MM Faria 
 

Correspondence Address:
A C Pinto





How to cite this article:
Pinto A C, Faria M M. Hypertrophic ileo-caecal tuberculosis with complete situs inversus (a case report). J Postgrad Med 1985;31:175-6


How to cite this URL:
Pinto A C, Faria M M. Hypertrophic ileo-caecal tuberculosis with complete situs inversus (a case report). J Postgrad Med [serial online] 1985 [cited 2020 Apr 10 ];31:175-6
Available from: http://www.jpgmonline.com/text.asp?1985/31/3/175/5390


Full Text



 INTRODUCTION



Situs inversus, also known as heterotaxia has been described since ancient times. This entity implies an organ arrangement that is opposite or reverse of the normal or is a mirror image of the normal. The frequency of its occurrence varies greatly from 1 in 35000 to 1 in 1379. In a study of 22402 autopsies by Rossler,[8] the frequency of occurrence was 1 in 7467 which might be accepted as the nearest possible approach to the correct incidence. We have come across, under our care, one such rare case of situs inversus and hence its presentation.

 CASE REPORT



Y. J., a 30 year old man, presented with a history of a lump in the left iliac fossa. He complained of an evening rise of temperature, loss of weight, loss of appetite and severe constipation for the past 6 months.

On examination, the patient was found to be asthenic with a small build. He had a scaphoid abdomen with a doughy feel on palpation. An intra-abdominal lump was felt in the left iliac fossa. Per rectal and proctoscopy examination was normal. He had dextrocardia with a precordial bulge on the right side.

A diagnosis of hypertrophic ileo-caecal tuberculosis with complete situs inversus was made after an X-ray of the chest which showed the heart on the right side. X-ray of the abdomen showed the liver to the left. Barium meal [Fig. 1] showed the stomach to the right and barium follow-through [Fig. 2] revealed the ascending colon on the left with signs of hypertrophic ileocaecal tuberculosis.

His haemoglobin was 12.5 gm%; CBC revealed lymphocytosis. ESR was 10 mm in the first hour (Westergren). Urine examination was normal but stool showed faintly positive occult blood. His blood group was B Rh +ve. His ECG was characteristic of dextrocardia.

A long, left, paramedian incision was taken and the abdomen opened in layers where upon a complete situs inversus was found. The liver was present along with its normal lobulations and the gall-bladder on the left side. The spleen was on the right side. The inferior versa cava was on the left whereas the aorta was on the right. The stomach was seen on the right side. The appendix was on the left alongwith a mass in the left iliac fossa with a lot of adhesions. The descending colon and the rectum were on the right side. A hemicolectomy was done with an end-to-end anastomosis.

Histopathology of the mass confirmed the diagnosis of hypertrophic ileo-caecal tuberculosis with tuberculous lymphadenitis. The patient was started an anti-tuberculosis regime. He is at present free of symptoms.

 COMMENTS



Situs inversus has been associated with various heart lesions[5] such as angina pectoris, chronic rheumatic, aortic and mitral endocarditis, myocardial infarction, calcareous aortic stenosis and corbovinum, corbilocular persistent truncus (ductus) arteriosus, abnormal systemic and pulmonary veins, arrested cardiac development, cor triloculare biventriculare, transposition of large vessels of the heart, aortic aneurysm of the auriculo-ventricular septum and Roger's disease. In the respiratory tract, it is associated with transposition of the lungs, congenital absence of one lung, bronchiectasis and the absence of or defective developement of the paranasal sinuses (Kartagener's syndrome). In the abdomen, transposition may be partial or complete, the latter being more common.[2] Some of the abnormalities are dextrogastria, atresia of the duodenum, polycystic kidney, absence of the spleen, anomalous lobulation of the spleen and liver, isolated situs inversus of the liver, partial transposition of the upper abdominal viscera, congenital obliteration of the bile ducts, non-rotation of the colon, megacolon, inversion of the colon below the splenic flexure and congenital absence of the anus and rectum with fistulous tract into the prostatic urethra.[5]

In a study of 111 cases, Merklin and Varano[7] classified cases of situs inversus into various categories such as (a) complete situs inversus, (b) dextrocardia, (c) partial situs inversus, (d) dextroposition of the heart, and (e) levocardia. In the present case, there were many critical defects (more than 50%) which made surgical intervention imperative. Cardiovascular defects were more frequent than the G.I. defects. Isolated cases of familial situs inversus have been described. A proposed relationship between situs inversus and twinning has been suggested.[6] Adams and Churchill[1] have suggested that there may be two main types of persons having transposition of viscera. First, the true mutant in which the tendency of transposition is inherited as a recessive character 4 and second, the true monster in which the transposition is a result of external influence acting on the developing embryo. The latter type is associated with other congenital abnormalities.

The mechanism by which situs inversus is produced in human beings has been described in detail by Cleveland.[3]

References

1Adams, R. and Churchill, E. O.: Situs inversus, sinusitis and bronchiectasis; Report of 5 cases including frequency statistics. J. Thoracic Surg., 7: 206-217, 1937.
2Almy, M. A., Volk, F. H. and Graney, C. M.: Situs inversus of the stomach. Radiology, 61: 376-378, 1953.
3Cleveland. M.: Situs inversus viscerum. anatomic study. Arch. Surg., 13: 343-368, 1926.
4Cockayne, E. A.: Genetics of transposition of viscera. Quart. J. Med., 7: 479-493, 1938.
5Johnson, J. R.: Situs inversus with associated abnormalities. Review of literature and report of three cases. Arch. Surg., 58: 149-162, 1949.
6Joyce, J. C.: Dextrocardia, situs inversus and twinning. Brit. Med. J., 2: 950-951, 1955.
7Merklin, R. J. and Varano, N. R.: Situs inversus and cardiac defects. A study of 111 cases of reversed assymetry. J. Thoracic and Cardiovasc. Surg., 45: 334-342, 1963.
8Rossler, H.: Bertrage zur lehre von den Angeborenen herzfehlern. Uber die Angeborenen isolierte rechtslager der herzens; Wien. Arch. F. Inn. Med., 19: 505, 1930. Quoted by Johnson (1949).[5]

 
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