Total Situs Inversus Found Coincidentally Following a Firearm Injury

Abstract

Situs inversus totalis is very rare and usually diagnosed coincidentally as it does not affect the patient's life. Being unaware of the patient's condition can lead to undesirable results from the surgeon and patient's point of view when an emergency and forensic surgical intervention is required. We present a case who was operated on urgently for a firearm injury after receiving a preoperative diagnosis of situs inversus totalis. In conclusion, situs inversus totalis can cause difficulties for surgeons in case of emergency surgery and is usually diagnosed coincidentally. There are a few cases of situs inversus with lung cancer in the literature but this is the first time a case with a firearm injury has been reported.

Concurrent hollow and visceral organs traumatic injury secondary to metal shrapnel penetration in a male with situs inversus totalis: A case report

“…Nature, velocity, and type of injury, as well as solid versus hollow organ involvement, result in various outcomes [5] , [6] . Indisputably, abnormal location can lead to diagnostic confusion and technical difficulties in surgery [1] , [2] . Normal routine exposure, manoeuvre and handling of the solid organs will be tricky as these types of patients are rare in incidents.…”

“…Preoperative planning with the anaesthetic team is mandatory in anticipating potential cardiac or pulmonary anomalies [1] . These associated congenital defects can lead to complex complications in polytrauma with multiple injuries [2] , [4] , [7] . Initial management follows a similar advanced trauma life support protocol.…”

“…Locating small objects in normal anatomy is already challenging enough, let alone in mirror-image anatomy. One can expect prolonged surgery as some adaptation is needed to identify the anatomical orientation as well as reversing the procedural steps in exchange for the left and right orientation differences [2] . Senior clinicians should be available as the vast experience of handling such cases is a huge aid in identifying the anatomy hence searching for the shrapnel will have a higher chance for success [1] .…”

“…Surgical management of this condition can be more complicated when the anatomy is mirror-image [1] . Situs inversus is a result of the embryological developmental anomaly [2] . It is also known with other names such as situs transversus or situs oppositus [3] .…”

Determining Trajectory to Predict Injury: The Use of X-Ray During Resuscitation in Gunshot Wounds

“…Furthermore, there have only been a few instances where authors have demonstrated utility of plain XR during resuscitation of a gunshot patient, but these are limited to thoracic injuries. 19,20 The use of CT scan to determine trajectory of bullets has been recognized since the 1980s. 21 Magnetic resonance imaging may also be a valuable tool in identifying structures injured by a bullet.…”