Asian Journal of Case Reports in Surgery

The presence of an abnormally positioned organ is known as situs ambiguous. Polysplenia is defined as the presence of more than one spleen. This is a case of a baby girl antenatal diagnosed to have bowel dilatation and at birth presented with gross abdominal distention and bile-stained aspirate. Derotation of the distal apple peel ileal deformity and alignment of opposing mesentery and end-to-end jejuno-ileal anastomosis was done. Total small bowel length of 37 cms was preserved. Post-operative period was uneventful and she was gradually weaned from total parenteral nutrition to full feeds by day 17. An important aspect to consider is that derotation for volvulus is contrary to the normal derotation of malrotation / volvulus and should be performed in a clockwise direction not anticlockwise. Other gastrointestinal anomalies associated with situs inversus are duodenal atresia, annular pancreas, biliary atresia, preduodenal portal vein, diaphragmatic hernia, lung cyst, genitourinary anomalies, ear, eye, and vertebral defects. Surgical principles remain same as for classic cases, though if there is any midgut volvulus derotation has to be performed in clockwise direction as volvulus in situs inversus will occur in anti-clockwise direction.