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Anatomy Atlases: Illustrated Encyclopedia of Human Anatomic Variation: Opus IV: Organ Systems: Stomach

Illustrated Encyclopedia of Human Anatomic Variation: Opus IV: Organ Systems: Digestive System and Spleen

Stomach

Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD

Peer Review Status: Internally Peer Reviewed


 

In complete transposition of the viscera, the stomach will lie on the right side.

Congenital hourglass constriction of the stomach is rare (46 of 50 cases reported, however, were in women).

Congenital stenosis of the pylorus occasionally occurs.

There may also be a doubled or tripled pyloric antrum, or the antrum may be replaced by a tube with thickened walls.

The fundus of the stomach sometimes has a diverticulum.

The stomach may be partially retroperitoneal (along with the spleen and left lobe of the liver). This is usually associated with defective mesenteries and omenta.

Heterotopic islands of pancreatic tissue have been found in the stomach wall.

Situs inversus has an incidence of 1:4000 in Japan, 1:5000 in Israel, and 1:10,000-15,000 in the United States and Northern Europe. Situs Inversus was recognized by Fabricus in 1600 when he described a case of reversed liver and spleen. Petrius Servius in 1615 described total transposition of viscera. Another similar observation was made by Riolan in 1668 in a case of an executed criminal and in the Queen of France, Marie de Medici (1573-1642), was still another authenticated case (Beck). Kuchenmeister in 1824 recognized situs inversus in a living person for the first time. LeWald demonstrated the difficulty in obtaining valid statistics for situs inversus. LeWald reports that on physical examination the reported frequency is 1/35,000, from the dissecting room 1/10,000, from post-mortem examination 1/5,000, and from roentgen examination 1/1,400.

In a study of 18,480 operated patients, 25 children and four adults had variations of position of abdominal viscera. In 15 cases there was one complete absence of intestinal rotation, three cases of incomplete rotation, nine cases of abnormal rotation, and two cases of situs inversus. Situs inversus has been associated developmentally with nonmotile cilia (Afzelius, 1976) and is transmitted as an autosomal recessive trait (Kartagner's syndrome). Immotile cilia resulting in sterility and chronic bronchitis may accompany situs inversus.

Image 6 Situs Inversus (Transposition of Viscera)


References

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Brunner, C. (1899) Ein Beitrag zur Chirurgie und pathologischen Anatomie der Darminvagination. Beitrag. z. Klin. Chir. 25:344-363.

Buckell, E. (1877) Transposed viscera from a pregnant woman, who died suddenly near full term. Post- mortem operation of Caesarian section, the child saved. Trans. Obstet. Soc. Lond. 19:179-184.

Cameron, J.L. and A. Nicholls. (1921) Two rare abnormalities occurring in the same subject. Partial absence of the corpus callosum. Stomach situated entirely within the thorax. Canad. Med. Assoc. J. 11:448-453.

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Cholst, M.R. (1947) Discrepancies in pain and symptom distribution. Position of the testicles as a diagnostic sign in situs inversus totalis. Am. J. Surg. 73:104-107.

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Clerc., A. and J. Bobrie. (1917) Dextrocardia sans inversion viscérale. Bull et Mém. Soc. Méd. de Hôp. de Paris. Serie 3 41:436-443.

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Colton, E.J., Anson, B.J., Gibbs, E.W., McCormack, L.J., Reimann, A.F. and E.H. Daseler. (1947) Positions of abdomonal viscera. Q. Bull. Northwestern University Medical School 21:154-155.

Cordress, 0. (1924) über ein Cor biloculare bei Situs viscerum inversus. Monatsschr. f. Kinderheilkunde 28:193-198.

Cornaz, -. (1859) Inversion splanchnique complète. Gaz. Hôp. 32:315-316.

DePaul, M. (1857) Imperforation congénitale du vagin; dilatation considéable de ce conduit avec accumulation de liquide dans son intérieur; estomac situé à droit. Soc. Biol. Comptes Rendus des Séances et Mémoires 9:46-48.

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Dubled, M. (1824) Cas de transposition des viscères; recueilli a hôpital Cochin (service de M. Bertin). Arch. Gén. Méd. 6:573-577.

Duguet, -. (1881) Transposition complète des viscères thoraciques et abdominaux. Soc. Biol. Comptes Rendus des Séances et Mémories 33:55-58.

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Ewart, G.A. (1921-22) A case of hour-glass stomach. Brit. J. Surg. 9:42-45.

Favaro, G. (1913) Les cavités pleurales rétrocardiaques de l'homme dans la transposition des viscères. Arch. Ital. Biol. 60:307.

Fleiner, W. (1916) Situs viscerum inversus abdominalis mit Eventration des rechtsgelagerten Magens und Stauungsekasie der Speiseröhre. Münchener Med. Wochenschr. 63:113-117.

Gachet, M. (1861) Observation de transposition du coeur et des autres viscéres chez un sujet de vingt et un ans du sexe féminin. Gaz. Hôp. 34:406.

Gardiner, J.P. (1907) A case of hour-glass stomach with accessory pancreas. JAMA (Journal of the American Medical Association) 49:1598-1600.

Gèry, L.H. (1843) De l'inversion complète des viscères; observation suivie de considérations généales sur ce sujet. Arch. Gén. Méd. 1:62-75.

Gorham, G.W. and J.G. Marselis. (1959) Kartagener's triad, a family study. Johns Hopkins Hosp. Bull. 104:11-16.

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Gross, R.E., Neuhauser, E.B.D. and L.A. Longing. (1950) Thoracic diverticula which originate from the intestine. Ann. Surg. 131:363-375.

Gruber, W. (1865) über das Vorkommen eines Mesenterium commune für das Jejuno-Ileum und die grössere Anfangshälfte des Dickarmes bei seitlicher Transposition der Viscera aller Rumpthöhlen. Resultate aus den bis jetzt gemachten Beobachtungen seitlicher Transposition der Viscera aller Rumpfhöhlen zugleich, oder jener der Bauch- und Beckenhöhle allein. Arch. Anat. Physiol. Wissen. Med. 1885:558-569.

Halff, J. (1904) Ein Fall von situs inversus des Magens, des Duodenums und der Milz bei einem 63jährigen, weiblichen Individum. Münchener Med. Wochenschr. 2:2287-2289.

Hardy, W. (1833) Transposition congénitale des viscéres. Arch. Gén. Méd. 3:277-278.

Harris, L.I. and B.P. Stivelman. (1927) Non-rotation of the stomach simulating spontaneous hydropneumothorax. JAMA 89:1836-1837.

Hauschild, M.W. (1922) über Situs inversus des Dünndarms infogle abnormer Drehung des Dünndarmgekröses. Anat. Anz. 55:110-122.

Hofmann, A.H. (1926) Familiärer situs inversus. Zentralbl. f. Chir. 53:1633-1634.

Hollinshead, W.H. (1969) Anatomy for Surgeons, 2nd ed. Harper & Row, New York.

Kartagener, M. (1933) Zur Pathogenese der Bronchiektasien. I Mitteilung: Bronchiektasien bei Situs viscerum inversus. Beitr. z. Klin. der Tubertk. 93:489-501.

Kartagener, M. and A. Horlacher. (1935) Bronchietasien bei Situs viscerum inversus. Schweiz. Med. Wochenschr. 16:782-784.

Kinney, L.C.(1921) Congenital non-rotation of the stomach. Am. J. Roentgenol. 8:383-385

Koller, A. (1899) Ein Fall von Situs inversus und seine Deutung. Arch. Pathol. Anat. Physiol. Klin. Med. 156:115-150.

Korfel, Z., Choinacki, M., Chilimoniuk, M. and I. Szewko-Swaykowska. (1973) Variations of position of the abdominal viscera in man. Folia Morphol. 32:71-78.

Korkiewicz, A. (1914) Situs inversus. Deutsche Med. Wochenschrift 40:1130.

Kreig, E.G. (1941) Heterotopic pancreatic tissue producing pyloric obstruction. Ann. Surg. 113:364-370.

Legroux, -. (1856) Cancer du pylore, - Diagnostic rendu douteux par une transposition générale des vicères. Gaz. Hôp. 29:466.

Levack, J.H. (1962-63) Duplication of ileum with heterotopic gastric mucosa and perforated peptic ulcer. Brit. J. Surg. 50:803-805.

LeWald, L.T. (1925) Complete transposition of the viscera. A report of twenty-nine cases, with remarks on etiology. JAMA 84:261-268.

Lineback, P.E. (1920) An extraordinary case of situs inversus totalis. Journal of the American Medical Association (JAMA). 75:1775-1778.

Lochte, -. (1898) Ein fall von situs viscerum irregularis, nebst einem Beitrag zur Lehre von der Transposition der arteriellen grossen Gefässstämme des Herzens. Beitr. Pathol. Anat. Allg. Pathol. 24:187-222.

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Ranier, F.J. (1908) Vier Fälle von topographischen Anomalien des Darmes. Internat. Monatschr. Anat. Physiol. 24:247-252.

Reid, D.G. (1908) Imperfect torsion of the intestinal loop. J. Anat. Physiol. 42:320-325.

Richards, W.F. (1944) Situs inversus viscerum, absent frontal sinuses with ethmoid and maxillary infection and bronchiectasis. Kartagener's triad. Tubercle 25:27-29. Cited in Excerpta Medica, Sec.1, vol. 2, abstract 527, p. 251, 1948.

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Schrank, J. (1887) Ein Fall von Situs transversus viscerum. Allgemeine Wiener Medicinische Zeitung 23:427.

Schridde, H. (1904) über Magenschleimhaut-Inseln vom Bau der Cardialdruzenzone und Fundusdrusenregion und den unteren, oesophagealen Cardialdrusen gleichenden Drusen im obersten Oesophagusabschnitt. Arch. f. Path. Anat. u. Physiol. u. f. Klin. Med. 175:1-16.

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