[Radical D2,D3 lymph node excision of stomach carcinoma in situs inversus totalis and malrotation of the colon].

The combination of Situs inversus totalis (SIT) with incomplete rotation of the colon is an extremely rare anomaly and especially of interest when presented with advanced gastric cancer. The routine en-bloc resection of gastric cancer with D2,D3 lymphadenectomy according to the recommendations of the Japanese Research Society for Gastric Cancer [5] can, as in this case, present tactical operative problems, due to the mirror-image anatomy and potential vessel anomalies, which might complicate the operative procedure. The preoperative diagnosis of SIT is not only essential to allow an adequate operative approach but furthermore to prevent vessel injury.