完全内臓逆位症に併発した早期残胃癌に対してESDを行った1例

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  • Early gastric remnant cancer with situs inversus totalis treated by endoscopic submucosal dissection

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A 78-year-old Japanese man was referred to the hospital for treatment of early gastric remnant cancer. He was diagnosed with situs inversus in childhood, and underwent partial gastrectomy and Billroth I anastomosis for gastric ulcer. Chest roentgenogram showed dextrocardia. Abdominal CT revealed transposition of the abdominal organs and no metastasis to the liver and lymph nodes. Upper endoscopic examinations showed a type 0−IIa＋IIc early gastric remnant cancer massively invading the sumucosa. Biopsy specimen disclosed moderately differentiated adenocarcinoma. A diagnosis of early gastric remnant cancer with situs inversus totalis was made. He did not agree to total gastrectomy worrying decline in activity, then endoscopic submucosal dissection was performed in the right decubitus position with change in the arrangement of staffs and equipments and careful usage of the devices.<br> Histopathological findings disclosed moderately differentiated tubular adenocarcinoma invading deeply the submucosa. He did not choose addition of the operation.<br> An endoscopic treatment for early gastric cancer accompanied by situs inversus totalis is thought suitable and effective in the right decubitus position.

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