Situs inversus Totalis: Always recall the uncommon.

Situs inversus totalis has been reported as a rare entity. The detailed knowledge of the human structure and its anatomical variations is of great importance for the daily clinical practice and even more critical in emergency medicine. Such a condition may elude in routine patient evaluation or an urgent interventional procedure, with potentially fatal results.

1. Question. Is it really essential for a clinician to be aware of rare variations of the human anatomy?

2. Answer. Situs inversus totalis (Figure 1) is a rare congenital condition with an incidence of approximately 1 in every 10.000‐50.000 live births.1 In fact it depicts a mirror image of the normal splanchnic anatomy with a complete inversion of the cardiac position (dextrocardia) and the abdominal viscera. The male to female incidence is 1:1 with no racial predilection. The exact cause of its appearance is still blurred. However it is linked with several factors including autosomal recessive genetic disorder with incomplete penetrance maternal diabetes cocaine use and conjoined twinning.2 Nevertheless the possibility of the simultaneous existence of further variations in anatomical structure like abnormal or absent spleen requires a thorough radiological examination before attempting any invasive procedure. A complete and elaborate diagnostic workup of such suspected cases seems to be a necessity for delivering proper care services in emergency departments. An expeditiously invasive procedure always underlies the risk of an unexpected anatomical barrier which may result in serious complications even death of the patient due to delay in efficient management 1, 2

Figure 1

Situs inversus totalis, computed tomography, abdomen‐thorax, coronal view, and venous phase (left side). 3D reconstruction of the same CT image depicting dextrocardia and the stomach inversion (right side)

CONFLICT OF INTEREST

None declared.

AUTHOR CONTRIBUTION

GT: wrote the manuscript and designed the clinical image. VT: involved in data collection. AF: involved in manuscript review and final approval.