Ascending colon cancer in a patient with situs inversus totalis: a case report and review of the literature

Introduction and importance: Situs inversus totalis (SIT) is a rare congenital condition characterized by the complete mirror-image transposition of thoracic and abdominal organs. Performing laparoscopic surgery in such patients presents unique technical and ergonomic challenges due to the reversed anatomy. Case presentation: We report the case of a 60-year-old male who presented with an incidental finding of an ascending colonic tumor during routine investigations. The patient was already known to have SIT. A laparoscopic-assisted ascending hemicolectomy was performed with reversed port placement and mirror-image surgical orientation. The procedure was completed successfully without intraoperative complications, and the postoperative recovery was uneventful. Clinical discussion: A review of the literature identified 12 previous laparoscopic colectomies, 2 robotic colectomies, and 1 robotic video vignette for ascending colon adenocarcinoma in SIT patients. This case adds to the growing evidence that laparoscopic-assisted colectomy is feasible and safe in SIT, provided that the surgeon is familiar with mirrored anatomy and adapts port placement and team positioning accordingly. Conclusion: Careful preoperative planning and anatomical orientation are key to a successful laparoscopic-assisted colectomy in patients with SIT.