We successfully saved a patient with pancreatoduodenal injury with situs inversus totalis by a pancreatoduodenectomy. A 46-year-old woman was brought to the hospital by ambulance because of a traffic injury. At the first medical examination, tenderness and muscular defense were noted in the left upper quadrant. X-ray films of the chest and abdomen showed dextrocardia and stomach bubble subphrenically on the right side. A CT scan of the abdomen revealed visceral inversion, enlargement of the pancreatic head, and a low-density area in the left anterior pararenal retroperitoneal space. We diagnosed the case as acute peritonitis due to traumatic injury of the pancreas, and performed an emergency laparotomy 3 hours after the injury. At laparotomy, there were about 500ml of bloody ascites and a fluid retention mixed with bile juice. And complete transections of the pancreatic head and descending part of the duodenum were revealed. Both lesions were resected.
All of the abdominal viscera showed right and left transposition. The visceral inversion did not constitute an intraoperative problem.