Adenosquamous carcinoma of the bile duct treated with pancreaticoduodenectomy in a patient presenting situs inversus totalis: A case report

Introduction: Situs inversus totalis represents an unusual anomaly characterized by a mirror-image transposition of the abdominal and thoracic viscera. It often occurs concomitantly with other disorders, hindering the diagnosis and management of abdominal pathology. The relationship between situs inversus totalis and cancer remains unclear. Presentation of case: We describe a 79-year old Japanese female with situs inversus totalis who presented with obstructive jaundice. Imaging and endoscopic examinations showed a mass in the distal common bile duct, which was identified as an adenocarcinoma on biopsy. The patient was successfully treated by cephalic pan-creaticoduodenectomy and the histological diagnosis was adenosquamous cell carcinoma. Ten months following surgery, the patient received chemotherapy and radiotherapy due to the presence of liver metastasis. Discussion and conclusion: The occurrence of an adenosquamous carcinoma of the bile duct in a patient with situs inversus totalis is an extremely rare coincidence. In this setting, when the tumor is resectable, surgical management should be considered without contraindication and must be preceded by careful preoperative staging.