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• W2898094128 abstract "Question: A 76-year-old man presented to the emergency department with a 3-day history of acute-onset severe left upper quadrant abdominal pain, nausea, and fever. The patient had no previous cardiovascular or gastrointestinal problems, or any history of allergy. However, his brother had been diagnosed with situs inversus totalis. On admission, the patient was febrile with vital signs within the normal range. On physical examination, the patient exhibited mild tenderness of the epigastrium and left upper quadrant with guarding and no rebound tenderness. Chest radiography revealed dextrocardia (Figure A), and abdominal ultrasound examination showed the spleen on the right side and the gallbladder on the left side with a left-sided sonographic Murphy’s sign. Chest and abdominal computed tomography (CT) scanning was performed (Figure B). What is the diagnosis? Look on page 880 for the answer and see the Gastroenterology website (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and images in GI. Abdominal CT scanning revealed transposition of all major abdominal organs, and biliary sludge and a thickened wall with pericholecystic changes were noted, consistent with acute cholecystitis. We made a diagnosis of acute cholecystitis with situs inversus totalis. Situs inversus is classified as partial (partialis) or complete (totalis). In partialis, the thoracic or abdominal organs are reversed; however, both are reversed in totalis. Situs inversus totalis is a congenital condition involving a complete mirror image transposition of the organs, and occurs in approximately 0.01% of the population.1Supriya G. Saritha S. Madan S. Situs inversus totalis – a case report.IOSR Int J Appl Phys. 2013; 3: 2278-4861Google Scholar There is no established gender-based or racial difference in the incidence. The precise genetic mechanism remains unknown, but > 20 genes are associated with this condition.2Casey B. Genetics of human situs abnormalities.Am J Med Genet. 2001; 101: 356-358Crossref PubMed Scopus (30) Google Scholar Situs inversus totalis is associated with primary ciliary dyskinesia. In particular, Kartagener's syndrome, which is currently classified as a subgroup of primary ciliary dyskinesia, consists of paranasal sinusitis, bronchiectasis, and situs inversus. Moreover, about 50% of patients with Kartagener's syndrome have situs inversus totalis.3Reidy J. Sischy S. Barrow V. Anaesthesia for Kartagener’s syndrome.Br J Anaesth. 2000; 85: 919-921Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar The prognosis for patients with situs inversus totalis, but without congenital heart defects or other underlying diagnosis, is good. Consequently, such patients are generally unaware of their unusual anatomy until they seek medical attention for an unrelated condition as demonstrated in the current case. More problematically, patients with situs inversus totalis who present to the emergency department may have diagnostic problems during physical examination because of their unusual anatomy, especially regarding disturbance of consciousness and unusual localizations of pains and symptoms. This condition presents a diagnostic problem that can be solved via medical imaging modalities, such as CT scans, ultrasound examination, and laparoscopy. In addition, surgery in these patients is technically challenging owing to the mirror image positioning of organs. Whether open or minimally invasive techniques are selected, the safe and effective treatment of patients with situs inversus totalis should be considered by clinicians." @default.
• W2898094128 created "2018-11-02" @default.
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• W2898094128 date "2019-03-01" @default.
• W2898094128 modified "2023-09-23" @default.
• W2898094128 title "Opposite Murphy’s Sign" @default.
• W2898094128 cites W1970370149 @default.
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• W2898094128 doi "https://doi.org/10.1053/j.gastro.2018.10.037" @default.
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