Incidental finding of situs inversus totalis in a patient of carcinoma ovary

Situs inversus totalis is a very rare congenital defect with incidence rate of about 1:10,000 live births [1]. It is characterised by transposition of abdominal and thoracic organs, viscera and vasculature. It results from rotation inopposite direction of viscera and organs during organogenesis [2]. It is an autosomal recessive condition and sometimes it can be X linked and also found in identical twins [3]. Our patient was a 45 year old female who was diagnosed to have carcinoma ovary and underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. CT scan abdomen revealed this condition. Images show that her organs are simply transposition in sagittal plane. The heart is located on right side of thorax (dextrocardia) with right sided aortic arch. The left sided lung has three lobes and right sided lung has two lobes (Image 1). The stomach, spleen are located on right side of abdomen, whereas liver and gall bladder are on left side (Image 2a & 2b). Blood vessels, lymphatics and intestines are also transpositioned. Uterus and ovaries can be seen absent. Patient was unaware of the condition throughout her life and it was incidentally diagnosed. This condition causes confusion for clinician as all the signs and symptoms will be on the other side of normal anatomical position of organ. It also complicates organ transplantation as donor organs will certainly come from situs solitus donors