Flipping the Script: Managing Carcinoma of the Esophagus in the Presence of Situs Inversus Totalis - Case Report and Literature Review

Introduction: Situs inversus totalis (SIT) refers to a mirror image reversal of the normal position of the internal organs. The incidence of situs inversus totalis is 1 in every 8,000 to 25,000 births, and the condition is most often diagnosed by radiographic examination. Only 12 cases of esophageal cancer with SIT have been reported worldwide. Here we report a case of left-sided hybrid VATS McKeown's Esophagectomy. Case Presentation: A 47-year-old male patient presented with progressive dysphagia to solids for 1 month. Endoscopy revealed inltrating growth at 3- 6 o'clock position starting 35cm. Punch biopsy demonstrated moderately differentiated squamous cell carcinoma. CECT scan revealed dextrocardia and situs inversus with liver, gall bladder, IVC on left side and aorta, spleen and sigmoid colon on the right and asymmetrical distal oesophageal wall thickening with luminal narrowing. After MTB approval, he underwent neoadjuvant concurrent chemoradiation as per CROSS protocol followed by left VATS McKeown's esophagectomy with standard two-eld lymphadenectomy in the right lateral decubitus position. Postoperative period was uneventful with length of hospital stay being 10 days. Final histopathology revealed pathological complete response with margin free of tumor. Patient kept on close follow-up. In the realm of rare anatomical anomalies, t Conclusion: he present case stands as a testament to the complexity and diversity of clinical challenges that medical professionals may encounter. The coexistence of esophageal cancer and SIT presents a formidable diagnostic and therapeutic puzzle. This report reiterates the need for constant adaptation, innovation, and multidisciplinary collaborations in the pursuit of enhancing patient outcomes.