The Journal of Medical Sciences
Volume 5 | Issue 1 | Year 2019

Anesthetic Management in a Case of Situs Inversus Totalis

Mohammed Nizamuddeen1, Hiremathada Sahajananda2

1,2Department of Anesthesiology, RajaRajeswari Medical College and Hospital, Bengaluru, Karnataka, India

Corresponding Author: Mohammed Nizamuddeen, Department of Anesthesiology, RajaRajeswari Medical College and Hospital, Bengaluru, Karnataka, India, Phone: +91 9886004910, e-mail:

How to cite this article Nizamuddeen M, Sahajananda H. Anesthetic Management in a Case of Situs Inversus Totalis. J Med Sci 2019;5(1):17–19.

Source of support: This article was supported by Department of Anesthesiology, RajaRajeswari Medical College and Hospital, Bengaluru, Karnataka, India

Conflict of interest: None


Situs inversus totalis is a rare syndrome, with an estimated prevalence of 1/10,000 births, characterized by the inverted position of the thoracic and abdominal organs with respect to the sagittal plane. The condition affects all major structures within the thorax and the abdomen. The etiological factors for which are still not completely understood. In a patient with situs inversus totalis, the anesthetic management during the respective surgical procedure is challenging. We are reporting a patient who was incidentally detected with situs inversus totalis with dextrocardia and was operated for Angle’s grade 3 malocclusion. The present case report lays an emphasis on the potential difficulties during anesthetic management and its various implications.

Keywords: Dextrocardia, Kartagener’s syndrome, Situs inversus.


The absence of heart sounds on auscultation at the precordial area raises the suspicion of one rare condition, dextrocardia, which could have been associated with situs inversus totalis.

During the embryological development, a 270° clockwise rotation instead of normal 270° anticlockwise of the developing thoracoabdominal organs results in mirror image positioning of the abdominal and thoracic viscera. The association of situs inversus totalis with syndromes, such as Kartagener’s syndrome, cardiac anomalies, spleen malformations, and other such clinical entities, makes the clinical scenario extremely challenging for the concerned anesthesiologist.1

The apex of the heart is located on the right side of the thorax, the stomach, and the spleen on the right hypochondriac region in the abdomen and the large lobe of the liver and gallbladder on the left side. The left lung is tri-lobbed and the right lung bi-lobbed and blood vessels, nerves, lymphatics, and the intestines are also transposed.2

This rare condition is well described by a few surgical and medical journals, but the anesthetic implications and considerations have not been thoroughly explained by any anesthesia specialty journal. We are reporting a case of situs inversus totalis who was operated for Angle’s grade 3 malocclusion with an aim of discussion of the anesthetic considerations and implications associated with such anatomical abnormalities.







1. Bajwa SJ, Kulshrestha A, et al. The challenging aspects and successful anaesthetic management in a case of situs inversus totalis. Indian J Anaesth 2012;56(3):295. DOI: 10.4103/0019-5049.98781.

2. Sharma S, Chaitanya KK, et al. Situs Inversus Totalis (Dextroversion) – An Anatomical Study. Anat Physiol 2012;2(5):112. DOI: 10.4172/2161-0940.1000112.

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