Laparoscopic adrenalectomy in a patient with situs inversus.

Kashiwagi, Shinichiro; Ishikawa, Tetsuro; Onoda, Naoyoshi; Kawajiri, Hidemi; Takashima, Tsutomu; Hirakawa, Kosei

BACKGROUND Situs inversus is a relatively rare congenital disease. A patient with a right adrenal tumor complicated by total situs inversus was treated by laparoscopy. CASE DISCUSSION The patient was a 45-y-old male with lower limb weakness. He had been diagnosed with situs inversus during a general health check-up as an infant. His blood pressure was 230/160 mm Hg, and the serum potassium level was 2.0 mEq/L. Abdominal ultrasonography and magnetic resonance imaging showed a mass of about 2cm in diameter in contact with the right adrenal gland. Total situs inversus was simultaneously confirmed. The plasma aldosterone concentration was elevated to 442pg/mL, and renin activity was suppressed, at 0.3ng/mL/hr. DISCUSSION These findings indicated a diagnosis of primary aldosteronism due to an adrenal tumor, and the right adrenal tumor was resected laparoscopically. The right adrenal gland was approached and resected from the lateral side of the spleen, which was located on the right side because of situs inversus. The resected specimen was 4.5cm x 1.6cm, and no intraoperative complications occurred. The histopathological examination showed the tumor to be an aldosterone-producing adrenocortical adenoma.