Urology Registrar Urology Department, John Hunter Hospital Newcastle, New South Wales, Australia
Background: Situs inversus totalis is a rare autosomal recessive disorder occurring in 1:8000 to 1:20000 people. Whilst cardiac and pulmonary anomalies are common in these patients. Renal cell carcinoma arising in a patient with situs inversus totalis has only been documented five times in the literature, and all of these patients underwent open nephrectomy. We report the first laparoscopic radical nephrectomy in a patient with situs inversus totalis.
Case Presentation: We present the case of a 62-year-old woman who had an incidental finding of a 10cm right upper pole renal lesion on ultrasound for investigation of gastrointestinal symptoms. She proceeded to computerized tomography of the chest and abdomen, which confirmed this finding and situs inversus totalis. There was no radiological evidence of lymphadenopathy or metastatic disease. After careful preoperative planning, she underwent a laparoscopic right radical nephrectomy. Her recovery was uncomplicated, and she was discharged on postoperative day two. Histopathology confirmed Clear cell renal cell carcinoma pT2aN0M0.
Conclusions: Renal cell carcinoma in a patient with situs inversus totalis is an infrequent entity and has previously been managed with open surgery. Laparoscopic radical nephrectomy can be performed safely and feasibly and should be the gold standard treatment paradigm for such patients. Meticulous preoperative planning is essential in the management of these complex cases.
ILLUSTRATION: Computerised tomography scan (coronal section) showing situs inversus totalis and large enhancing 10cm right upper pole renal lesion