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Primary Ciliary Dyskinesia (PCD) and Kartagener Syndrome (KS) are rare genetic disorders. PCD occurs in patients with recurrent sino-pulmonary infection, dextrocardia, chronic vasomotor rhinitis, and bronchiectasis. This study reports a rare case of KS for having further awareness of this disease. According to this study, this disease should be considered in patients with recurrent respiratory infections, because early diagnosis and timely treatment of these patients can lead to reduced irreversible complications and increased life expectancy.

Dextrocardia is an unusual inherent positioning of the heart: during fetal life, the heart is flipped to the right side rather than the usual left side. Situs inversus is a rare congenital ailment in which the main internal organs are rearranged or reflected from their natural positions, and when both conditions are present, it is called situs inversus totalis. The majority of the people with situs inversus totalis are unaware of the situation they have because most of them are asymptomatic. It is usually discovered incidentally when they consult the doctor for an unrelated condition. We are reporting a case of a 55-year-old woman who was found to have a situs inversus totalis with an absent left kidney.

We present the case of a 74-year-old man with dextrocardia and situs inversus who presented with non-ST-elevation acute myocardial infarction. The patient underwent successful coronary angiography without requiring percutaneous coronary intervention or coronary artery bypass grafting. We discuss the patient's clinical characteristics, electrocardiography findings, diagnosis, and treatment, and review the relevant literature., Competing Interests: We would like to state that (1): This manuscript, or part of it, neither has been published nor is currently under consideration for publication by any other journal (2); All relevant data are within the paper (3). Thanks to Li Daixu for providing us with valuable cases (4).All authors had full access to the data and agree to the manuscript as written (5); The authors have declared that no competing interests exist., (© 2024 The Authors.)

Scimitar syndrome is characterized by the anomalous connection of the right pulmonary venous return to the hepatic portion of the inferior vena cava. Its name is derived from the characteristic image observed in chest X-ray, CT scan, or during pulmonary angiography in cardiac catheterization. It is more common among females and rarely affects the left lung. The importance of knowing its symptoms and presentation allows for a high diagnostic suspicion, thus avoiding the underdiagnosis of the disease. The prognosis is generally good, and timely diagnosis can prevent the occurrence of complications such as pulmonary hypertension or portal hypertension. We present the case of an eight-year-old female patient, who was previously evaluated for episodes of lower respiratory tract infections at 18 months of age, detecting only dextroposition, without any diagnostic workup. She was then sent to our office at eight years of age, with the onset of exercise-induced dyspnea. A comprehensive workup was conducted, with a diagnosis of scimitar syndrome., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Tomás Alvarado et al.)

Cryoballoon ablation has been established as an effective method for pulmonary vein isolation and has recently been investigated for its efficacy of substrate modification on the left atrial roof area in patients with persistent atrial fibrillation. We herein report the first successful case of left atrial posterior wall isolation including roof line ablation using cryoballoons in a patient with persistent atrial fibrillation, dextrocardia, and situs inversus. Cryoballoon ablation proved to be a safe and straightforward approach to create lasting lesions along the left atrial roof line and left atrial posterior wall, even under challenging anatomical conditions.

A significant number of patients with dextrocardia and other cardiac malpositions have other congenital heart defects (CHDs). The incidence of CHDs in subjects with cardiac malpositions is significantly greater than that in normal children, and the prevalence varies with the associated visceroatrial situs. The most useful approach to diagnosis is segmental analysis. Firstly, dextroposition should be excluded. In segmental analysis, the visceroatrial situs, ventricular location, status of atrioventricular connections, the great artery relationship, and conotruncal relationship are determined with the use of electrocardiogram (ECG), chest X-ray, and echocardiographic studies, and, when necessary, other imaging studies, including angiography. Following identification of the afore-mentioned segments, the associated defects in the atrial and ventricular septae, valvar and vascular stenosis or atresia may be determined by a review of the historical information, physical examination, and analysis of chest roentgenogram, ECG, and echocardiographic studies. Along the way, a pictorial rendition of the terminology and diagnosis of cardiac malpositions is undertaken.

Anomalies of the inferior vena cava (IVC) are often discovered incidentally, yet they pose significant challenges in both diagnosis and treatment. This study discusses a case of a 50-year-old female with situs inversus and well-differentiated cholangiocarcinoma, emphasizing the rarity and complexity involved. Imaging studies confirmed the presence of dextrocardia, abdominal situs inversus, and an interrupted IVC with continuation to the azygos vein. A thorough understanding of IVC embryology is crucial, as it helps explain the pathogenesis of such anomalies, which arise from disturbances in the embryonic venous system leading to various anatomical variations. Managing an interrupted IVC is critical due to the potential for vascular complications, highlighting the need for preoperative awareness. This study underlines the importance of recognizing and properly managing these rare vascular anomalies to improve patient care., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Castillo Reina et al.)

We herein report a 76-year-old woman with situs inversus and dextrocardia who underwent pacemaker implantation for sick sinus syndrome. Situs inversus with dextrocardia, which is frequently associated with cardiovascular malformation, is a rare congenital malformation wherein the thoracic and abdominal viscera are inverted compared with their normal positions. This renders the implantation of cardiac devices an arduous task. We therefore decided to gather preoperative anatomical information on patients with situs inversus and dextrocardia. We used three-dimensional computed tomography to collect preoperative information in order to facilitate the safe implantation of cardiac devices.

Kartagener's syndrome is an uncommon autosomal recessive ciliary dyskinesia. It combines a triad comprised of bronchiectasis, chronic sinusitis, and situs inversus. This work aims to describe the clinical and paraclinical aspects of primary ciliary dyskinesia using Kartagener's syndrome as a model and to highlight the difficulties of confirming the diagnosis in our context. We report four observations (three boys and one girl with an average age of 10 years) of Kartagener's syndrome collected in the department of pediatric pneumo-allergology. Chronic bronchorrhea and otorhinolaryngological manifestations were found in all cases. Signs of neonatal respiratory distress syndrome were found in only one case. One child had dysmorphic facial features suggestive of Noonan's syndrome and conductive hearing loss. Digital hippocratism was found in half of the cases, along with pulmonary crackles and heart sounds perceived on the right. A chest CT scan showed bronchiectasis in all patients and necrotic adenopathy suggestive of tuberculosis in one case. Sinus imaging showed an appearance of pansinusitis. All children had abdominal situs inversus with dextrocardia. They had received antibiotic therapy with amoxicillin-clavulanic acid associated with respiratory physiotherapy. The girl had benefited from a right lobectomy with a follow-up of 18 months and a good evolution. In light of these four observations, Kartagener's syndrome is a rare disease but can be compatible with normal life if the treatment is done early. However, in our context, the difficulty of confirming the diagnosis explains its delay with the risk of progression of pulmonary lesions., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, El Marzouki et al.)

This article discusses a rare case of a 31-year-old male patient who presented with dextrocardia and persistent truncus arteriosus. The patient had a history of poor exercise tolerance and cyanosis following exercise. Physical examination revealed clubbing in the fingers and toes, and imaging tests confirmed situs inversus and persistent truncus arteriosus. Whole genome sequencing identified a specific genetic variant. This case highlights the coexistence of dextrocardia and persistent truncus arteriosus in adulthood. The article provides detailed information about the patient's condition and includes contributions from multiple authors. [Extracted from the article]

This article, published in Neurology India, describes the case of a 60-year-old male patient who was admitted to the Neurology Outpatient Department with symptoms of dizziness, frontal headache, and diabetic imbalances. The patient experienced convulsions and tongue injury, and was transferred to the NeuroICU where he required intubation. The article discusses the patient's medical history, physical examinations, and diagnostic findings, including an incidental diagnosis of dextrocardia on a chest X-ray. The authors affirm that they have obtained necessary patient consent for the publication of the article and images. The study was conducted in adherence to ethical principles and there are no conflicts of interest. [Extracted from the article]

BACKGROUND: Palliation of functional single ventricle continues to be the standard surgical treatment with extracardiac Fontan (ECF) being the final common pathway. ECF is commonly performed using PTFE grafts. Although it is rare, PTFE grafts can be subjected to calcification and obstruction which may require repeat operations. We aim to present an alternative strategy to manage obstructed/calcified Fontan conduits. Methods: An 18-year-old man with functional single ventricle secondary to unbalanced AVSD with pulmonary atresia and TGA. He also had asplenia and dextrocardia. He underwent all his three-stage palliation through median sternotomy with an aortopulmonary shunt, Bidirectional Glenn, and prior Fontan. He had a polytetrafluoroethylene (PTFE) graft conduit for his extracardiac Fontan, but it appeared to be calcified and obstructed on his most recent cardiac catheterization. Based on this finding, the decision was made to replace his conduit. Results: Through a 4th sternotomy, the main pulmonary artery stump was ligated and divided. After dissection of the conduit, the decision was made to add a new graft from the inferior vena cava to the right main pulmonary artery instead of explanting the entire Fontan conduit. This was done to avoid placing the new Fontan connection facing towards the left sided Glenn connection. A sidebiting clamp was then placed on the inferior vena cava, leaving a portion of inferior vena cava as well as the left sided hepatic vein to drain through the previously placed Fontan conduit. An end-to-side anastomosis between a 20 mm ringed PTFE graft and the inferior vena cava was constructed using running 5/0 prolene suture. Clamp was removed and the graft was de-aired and adjusted. After which an arteriotomy was made and the distal graft to pulmonary artery anastomosis was constructed using running 6/0 prolene suture. He was extubated in the operating room and was discharged 9 days later. Table 1 displays his post-operative course. Post-operative CTA showed widely patent flow through the two extracardiac Fontan conduits. Image 1. Conclusions: Utilization of small PTFE grafts at the time of initial Fontan completion should be avoided. Transcatheter options on smaller Fontan conduits especially when calcified are limited. Repeat operations may be necessary to improve cardiac output and decrease the risks related to hepatic and renal dysfunction secondary to the obstructed conduit. The off-pump strategy is feasible, even in positional anomalies and helps avoid transfusions which may impact the Fontan circulation in the perioperative period. [ABSTRACT FROM AUTHOR]

This article discusses a case of a 38-year-old woman with scimitar syndrome and hemi-cor triatriatum. The patient presented with symptoms of exertional dyspnea and was initially diagnosed with an atrial septal defect. Further examination revealed dextrocardia, cardiomegaly, and other cardiac abnormalities. Imaging tests confirmed the presence of scimitar syndrome, hemi-cor triatriatum, and anomalous pulmonary venous drainage. This case highlights the need for careful evaluation and vigilance when assessing similar cases, as well as the embryological basis of left atrial development and pulmonary venous incorporation. [Extracted from the article]

Abstract Patients with genetic disorders are potentially more susceptible to present vascular abnormalities compared to the general population. For these patients, unusual difficulties could appear during a CVC placement procedure that could lead to major complications if venous abnormalities are undiagnosed. Ultrasound and fluoroscopy guidance should be used routinely for all patients in order to avoid complications and catheter misplacement.

Keywords: Dextrocardia; Orientation; Projection EN Dextrocardia Orientation Projection 111 113 3 10/12/22 20221001 NES 221001 Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s10840-022-01224-x. Although projections used in our case with dextroposition resemble projections used in patients with dextrocardia and situs inversus or solitus, the heart rotates more counterclockwise in patients with dextrocardia. [Extracted from the article]

A 71-year-old lady with dextrocardia and pure aortic regurgitation was treated with transcatheter aortic valve replacement using the transapical J-valve system. Good clinical and echocardiographic results were demonstrated at one-year follow-up. Herewith we describe this simple, safe, and a minimally invasive aortic valve replacement option for this condition. [ABSTRACT FROM AUTHOR]

Background: Dextrocardia is a rare congenital abnormality in the general population, with an estimated incidence of 1 in 12,000 live births. Isolated dextrocardia, the condition of right-sided heart with situs solitus is most commonly referred to as dextroversion. Case Presentation: A 2-month-old Ugandan baby boy discovered to have isolated dextrocardia with situs solitus presented with fever, cough, and difficulty in breathing. Physical examination revealed moderate respiratory distress, bilateral basal fine crepitations, tachycardia with regular pulse, and heart sounds best heard on the right hemithorax, but no murmurs. Chest X-ray confirmed right-sided cardiac shadow with cardiac apex pointing to right. Echocardiography showed D-loop ventricular morphology with right cardiac axis and ventricular apex to right, plus tiny patent ductus arteriosus. Abdominal ultrasound showed normal situs solitus; however, the left kidney was noted in pelvic space. Conclusion: Isolated dextrocardia with situs solitus (dextroversion) is a rare scenario. This case exhibits a learning point in the significance of routine medical examination of patients to identify anomalies and upon suspicion a thorough evaluation to prevent wrong diagnosis or poor prognosis due to delayed management. [ABSTRACT FROM AUTHOR]

The recognition of situs inversus is of great importance to avoid possible surgical mishaps that may result from the failure to recognize reversed anatomy or an atypical history. The repair of associated PAPVC with situs inversus totalis needs special attention during surgery due to the reversed anatomy.ss [ABSTRACT FROM AUTHOR]

Many types of malignant salivary gland tumors (SGTs) have been identified thus far, despite the rarity of these tumors. Furthermore, salivary glands comprise three paired major glands and numerous minor glands that are widely distributed in the upper aerodigestive tract region. Because of this arrangement, tumor management is complicated and cumbersome. Here, we describe polymorphous adenocarcinoma (PAC) in the sublingual gland in an 81-year-old woman with a congenital cardiac anomaly (dextrocardia). We observed a new relationship in PAC between beta-catenin and AHI-1. Further studies may provide beneficial information for PAC to establish a detection protocol or method for tumor treatment. We suggest that basic information regarding cases of PAC should be reported. [ABSTRACT FROM AUTHOR]

Abstract The recognition of situs inversus is of great importance to avoid possible surgical mishaps that may result from the failure to recognize reversed anatomy or an atypical history. The repair of associated PAPVC with situs inversus totalis needs special attention during surgery due to the reversed anatomy.ss

Dextrocardia with situs inversus totalis is a rare congenital abnormality. Most coronary artery bypass grafting surgeries in patients with dextrocardia were performed with anastomosis, using the right internal thoracic artery to revascularize the left anterior descending. It should be noted that in the literature there are few reports of coronary artery bypass grafting surgery, in a patient with this abnormality, its anatomical complexity constitutes a challenge in planning the surgical technique and the grafts to be used. We present an unusual case of a patient with situs inversus totalis and coronary artery disease who underwent coronary artery bypass grafting surgery making it a more technically complex procedure for surgeons, in addition to the difficulty in choosing grafts.

Dextrocardia with a ductus arteriosus (DA) malformation is extremely rare. Here, we present a case of dextrocardia complicated with a right DA that is circuitously connecting the pulmonary artery and the right brachiocephalic artery. Coincidentally, the deformities of this fetus are almost symmetrical with those in another fetus (also presented here), which is astonishing and meaningful. Dextrocardia is rare, complicated, and not well understood. In this report, we carefully compared prenatal echocardiographic images and cardiovascular casts from two fetuses. Our report of these cases may provide new insights for cardiologists to better understand dextrocardia and its associated malformations. [ABSTRACT FROM AUTHOR]

Transcatheter closure of secundum atrial septal defect (ASD II) is considered the treatment of choice when anatomically suitable and clinically indicated. This is routinely done through the inferior vena cava via a femoral venous approach; however, certain anatomical anomalies, such as congenital interruption of inferior vena cava with azygos continuation, render the delivery of the device either difficult or not possible. When this anomaly is also associated with dextrocardia, the technical challenge increases further due to the unusual orientation of the interatrial septum. We describe a case of transcatheter closure of ASD II via left internal jugular vein approach with some modification of the standard technique. We used a combination of veno-arterial rail by parking the super-stiff wire in the descending aorta instead of the usual method of parking it in the pulmonary vein for better support, and over the wire technique during device deployment to maintain the delivery sheath position during device deployment. Changing the vascular access with the modification of the standard technique of closure was the key to success in this patient. < Learning objective: Transcatheter atrial septal defect closure in patients with interrupted inferior vena cava can be successfully performed via trans jugular approach using a combination of veno-arterial rail and over the wire technique as a technical modification to the standard procedure's steps inorder to increase the support while crossing with the delivery sheath and maintain its position during deployment of the device.> [ABSTRACT FROM AUTHOR]

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Background: Total anomalous pulmonary venous return (TAPVR) refers to an anomaly in which all of the pulmonary veins drain directly or indirectly to the systemic venous circulation. However, unusual types constitute approximately 5% or less of TAPVRs and there may be obstruction or discontinuity of pulmonary vein at various levels.Case Presentation: A 3-month-old infant was presented to us with history of poor feeding, respiratory distress and desaturations. The routine echocardiographic investigation initially confirmed the diagnosis of an atrial septal defect with dextrocardia. However, due to disproportionate severity of symptoms and congestive heart failure a cardiac computer tomography angiogram was done that revealed a rare finding of connection of pulmonary veins fused with the posterior atrium, but on the rightward side of the deviated atrial septum. Therefore, pulmonary veins entered a sinus that drains directly into the right atrial superior-posterior wall. During surgical repair, we found an area of absent pericardium in the diaphragmatic surface of the heart. The patient underwent total repair of the TAPVR and patch reconstruction of the pericardial defect. The patient is doing well at 6-month follow up.Conclusions: The septum primum malposition defect resulting in TAPVR is a very rare congenital anomaly that can be rarely seen without any heterotaxy. The anomalous features including absent pericardium and dextrocardia were present in this patient have not been described previously with TAPVR. Therefore, we have hypothesized the embryological correlation of absent pericardium and cardiac malposition in such case. Transthoracic echocardiography with Doppler interrogation is a reliable method for diagnosing this condition. In case of suboptimal echocardiographic image due to cardiac position, unclear anatomy or unexplained symptoms, advanced imaging such as computer tomographic angiography or cardiac magnetic resonance imaging can be very helpful. Preoperative proper diagnosis of this anomaly facilitates successful surgical management with excellent outcome. [ABSTRACT FROM AUTHOR]

Dextrocardia is a rare congenital anomaly, whereas its association with sick sinus syndrome in young adults without accompanying heart abnormalities is exceptional. We report a case of a 38 year old female patient who was admitted to our hospital due to syncope as a consequence of sinus pauses up to 4.9 seconds. She was also diagnosed with situs inversus totalis, with mirror image dextrocardia. Pacemaker implantation was indicated. Under local anesthesia, from the left subclavian vein, the guide wire was passed through superior vena cava to the right atrium and ventricle without any obstacles. In conclusion, situs inversus totalis with mirror image dextrocardia may present in combination with sick sinus syndrome as early as the fourth decade of life. Implantation of pacemaker leads from the left subclavian vein appears accessible and safe in patients with dextrocardia with situs inversus (mirror image). [ABSTRACT FROM AUTHOR]

Rationale: Genotype-phenotype relationships are emerging in primary ciliary dyskinesia (PCD), but little is known about lung volume changes over time. Objectives: To investigate the evolution of static lung volumes with ultrastructural defects, gene mutations, body mass index, and specific infections in PCD. Methods: Prospective, longitudinal, single-center study in children and adults evaluated twice yearly for up to 10 years. Linear mixed-effects models were used to assess associations between ciliary morphology, genetic mutations, and clinical features. Results: A total of 122 patients had 1,096 visits. At enrollment, almost all spirometric and, especially in adults, plethysmographic parameters were significantly worse in absent inner dynein arms (IDAs), central apparatus (CA) defects, and microtubular disorganization (MTD) (IDA/CA/MTD) compared with patients with normal electron microscopy (EM) results. The mean trend increase with time for residual volume (RV) was significantly higher in IDA/CA/MTD group compared with groups with outer dynein arm defect and normal EM results. The mean trend of RV/total lung capacity in the IDA/CA/MTD group was significantly worse than in all other groups. The steepest rise in lung volumes was in CCDC39 and CCDC40, whereas hyperinflation increased less in DNAH5 and DNAH11 groups. RV/total lung capacity showed a significantly steeper rise in patients with Pseudomonas aeruginosa compared with patients with other infections or patients without infection. Conclusions: Patients with IDA/CA/MTD defects or CCDC39 and CCDC40 mutations had the greatest increase in hyperinflation, whereas those with outer dynein arm defect and normal EM results or DNAH11 and DNAH5 mutations had less severe changes. We have robustly confirmed the worse prognosis for some genetic and ultrastructural defects, which association hitherto rested solely on spirometry. [ABSTRACT FROM AUTHOR]

We describe the occurrence of acute type A aortic dissection in a patient with situs inver-sus totalis. A 37-year-old man presented to the emergency department with acute chest pain. Initial chest X-ray findings showed a right-sided heart and a left-sided liver. Con-trast-enhanced computed tomography revealed a Stanford type A acute aortic dissection, aortic root dilatation, and situs inversus totalis. All of the thoracic structures were mirror-im-age reversed and an abnormal coronary artery was observed. The Bentall operation was performed. This report demonstrates that computed tomography and echocardiography were useful for understanding the anatomy and the presence or absence of concurrent anomalies in a patient with situs inversus totalis. The patient’s postoperative course was uneventful.

Abstract A 51‐year‐old man with dextrocardia and complete situs inversus who presented with palpitation as a result of drug refractory paroxysmal atrial fibrillation (AF) was referred to our hospital for catheter ablation. Pulmonary vein isolation (PVI) was performed using the HotBalloon technique. We were able to accomplish AF ablation safely and easily using 180 degree‐inversed mirror images of X‐ray fluoroscopy. We have reported successful PVI for AF with dextrocardia using HotBalloon and mirror image of X‐ray fluoroscopy without any complication for the first time.

Abstract Cryoballoon ablation of an arrhythmogenic focus alongside a pulmonary vein as an alternative to radiofrequency ablation may be feasible and safe in patients with situs inversus and dextrocardia.

Background & aim: Dextrocardia is a cardiac positional abnormality in which the heart is located in the right hemotorax with the apex axis to the right. Dextrocardia is a rare anomaly with a prevalence of about 1 in every 10,000 people. The aim of this study was to determine and report a pregnancy in a woman with dextrocardia with liver hemangioma. Case Report: A 30-year-old woman, with a first pregnancy, 34 weeks gestational pregnancy, reported cardiac and abdominal visceral displacement. Mild mitral valve insufficiency was reported in echocardiography and in ultrasound, spleen and liver in the left upper quadrant and right ventricle and in the midline (Situs inverse) and an echogenic mass suggestive of hemangioma. The liver is. The size of the hemangioma in this ultrasound did not change compared to pre-pregnancy ultrasound. Also, NT1 ultrasound and normal and fetal scan anomalies showed no abnormalities or displacement of viscera. Conclusion: In spite of the rare occurrence of dextrocardial malformations, thorough physical examination and ultrasound should be performed in such cases and in the absence of syndromic anomalies, they will most likely have a risk-free pregnancy.

Poland's syndrome is a rare congenital anomaly accompanied by the absence of the pectoralis major, and the ipsilateral upper-limb and chest wall deformities. Hypoplasia of the breast, agenesis of the ipsilateral rib cartilage, athelia, and ipsilateral developmental finger anomalies such as syndactyly can also be seen. In the literature, only 56 cases of dextrocardia and left-sided Poland's syndrome have been described. Herein, a case of left-sided Poland's syndrome coexisting with dextrocardia and nasal hemangioma was presented.

Doğumsal diyafram evantrasyonu ve otozomal dominant polikistik böbrek diğer organ ve sistem tutulumlarının da eşlik edebildiği hastalıklardır. Daha önceden bilinen herhangi bir hastalığı, geçirilmiş travma ya da cerrahisi olmayan 84 yaşında erkek hastanın 2 gündür solunum sıkıntısı, gaz gaita yapamama, karın ağrısı, karında şişlik, bulantı-kusma şikayetleri varmış. Son birkaç saat içinde karın ağrısında şiddetlenme ve ani solunum yetmezliği gelişmesi üzerine başvurdu. Bilgisayarlı tomografide sigmoid volvulus, içi boş organ perforasyonu, dekstrokardi, diyafram evantrasyonu, karaciğer ve böbreklerde multipl kistler saptandı. Hastaya sigmoid rezeksiyon ve kolostomi açılması işlemi uygulandı. Ameliyat sonrası erken dönemde genel durumu düzelen hasta 4. günde sorunsuz şekilde taburcu edildi. Birden fazla sistemi ya da organı tutan patolojiler hastanın kliniğinde beklenenden daha hızlı ve gürültülü bozulmaya sebep olabilmektedir. Böyle hastaların bir bütün olarak değerlendirilmesi tedavinin daha doğru planlanmasını, böylece hastada morbidite ve mortaliteyi artırabilecek gereksiz işlemlerin önüne geçilmesini sağlayacaktır.