Journal of Postgraduate Medicine
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Year : 1986  |  Volume : 32  |  Issue : 1  |  Page : 45-46A  

Perforated duodenal ulcer with dextrocardia with situs inversus.

DM Gandhi, PP Warty, AC Pinto, SV Shetty 

Correspondence Address:
D M Gandhi

How to cite this article:
Gandhi D M, Warty P P, Pinto A C, Shetty S V. Perforated duodenal ulcer with dextrocardia with situs inversus. J Postgrad Med 1986;32:45-46A

How to cite this URL:
Gandhi D M, Warty P P, Pinto A C, Shetty S V. Perforated duodenal ulcer with dextrocardia with situs inversus. J Postgrad Med [serial online] 1986 [cited 2023 Sep 30 ];32:45-46A
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Dextrocardia with situs inversus is a diagnostic curiosity. Perforated duodenal ulcer in a case of situs inversus has not been reported in literature. We had under our care, at Dr. R. N. Cooper M.G. Hospital, Bombay such a case. The rarity of the condition prompts us to publish the case report.


A 24 years old non-smoker and non-alcoholic male was admitted with sudden onset of epigastric pain and vomiting. There was no history of fever, distension of abdomen, constipation or similar episode in the past. The physical examination revealed a pulse rate of 96/min, BP 120/76 mmHg and the patient was afebrile. Examination of abdomen revealed guarding and rigidity especially in epigastrium and left hypochondrium. The liver dullness was demonstrable on left side. However, peristalsis were absent The complete haemogram showed Hb 9.5 gm% with a white cell count of 10,000/cmm with neutrophilia. His blood group was 0 +ve and the biochemical investigations were essentially normal. The X-ray abdomen taken in vertical position showed fundic gas shadow under the right dome of diaphragm and the liver shadow on the left side. However, there was free gas under both domes of diaphragm [Fig. 1]. The chest X-ray showed dextrocardia. ECG was diagnostic of dextrocardia without any other abnormalities. The clinical diagnosis of perforated duodenal ulcer in a case of dextrocardia with situs inversus was made.

After an initial management with intra venous fluids, antibiotics and nasogastric aspiration, the patient was subjected to an exploratory laprotomy. The diagnosis of perforated duodenal ulcer was confirmed. There was acute perforation 4 mm in diameter in the anterior wall of first part of duodenum. Exploration of the rest of the abdomen showed features typical of situs inversus totalis. The Graham closure of the duodenal ulcer was done with non-absorbable sutures, a thorough peritoneal lavage was given; an incidental appendicectomy was also performed to avoid further diagnostic problem and abdomen was closed in layers. The patient had an uneventful recovery. Post-operative barium follow through was done for demonstration of situs inversus.


Dextrocardia with situs inversus is a relatively rare condition, the incidence being 2 per 10,000.[1] The diagnostic enigma in an acute abdominal condition arises out of visceral transposition. The importance of recognising the presence of condition pre-operatively, is emphasized by the fact that the proper surgical incision can be used for an exploration of the abdomen. Certain congenital anomalies like polysplenia, asplenia or Kartagener's syndrome are known to occur with such patients.[1],[3] However, our patient did not have any of the abnormalities. Diagnosis was made pre-operatively and an exploratory laprotomy was performed with left paramedian incision. Peptic ulcer associated with situs inversus has been reported earlier.[4]


1Almy, M. A., Volk, F. H. and Graney, C. M.: Situs inversus of stomach. Radiology, 61: 376-378, 1953.
2Johnson, J. R.: Situs inversus with associated abnormalities, review of literature and report of 3 cases. Arch. Surg., 58: 142-162, 1949.
3Willis, J. H.: The Heart. 5th edition, McGraw Hill Book Company, New York, 1982, p. 817.
4Zaporozhets, V. K., Chupryna, V. V., Vasilenko, N. J. and Mal'ko, V. I.: Iazvennaia bolelzn' zheludka pri polnoi inversii vnufrennikh organov. Klin. Med. (Mosk), 58: 95-96, 1980.

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