Malrotation and malfixation of the intestinal tract have long been recognized as clinical entities. They have a variety of clinical presefitations. Malrotation of two organs is relatively rare. In this case report, we present a very rare (the fifth case) of situs inversus and malrotatin of the intestrnal tract. Since the rotation of the intestinal tract And placement of the heart occurs simultaneously at the fourth week of fetal life, probably a - single etiology is responsible for such a presentation.

Abdominal pain is a common complaint in patients presenting to the emergency department. It is estimated that 4 to 8 % of emergency department visits for adults is abdominal pain. Causes of abdominal pain are many and varied depending on age, sex and underlying physiological, pathological or developmental variables and usually detailed a list of differential diagnoses. There are variable acute abdomen manifestations in patients with situs inversus. Development of abdominal Visceral nerve in situs inversus is normal and incidence of acute abdominal pain is same as in patient without situs inversus and is felt in the same site.In this article, two cases of acute abdomen, acute appendicitis and gallbladder inflammation that manifestated with pain and tenderness in the right abdomen. Further examinations and during surgical intervention it was revealed that they had situs inversus.

Background: situs inversus is often detected incidentally in adults during imaging for an acute surgical emergency. We present a case of acute appendicitis in an adult who was previously unaware about his situs anomaly. A laparoscopic approach is helpful to deal with this condition.Case Report: A 16-year-old girl was admitted with history of acute abdominal pain. Clinically, she was diagnosed as acute appendicitis without any localized peritonitis. Subsequent imaging studies and lapartomy confirmed the diagnosis of situs inversus and acute left-sided appendicitis. She successfully underwent laparotomic appendectomy. Her postoperative recovery was uneventful. Morever, the patient had lagre and hemorrhagic cytes in every two ovaries that excisioned during the operation. Technically, more challenging because of the reverse laparoscopic view of the anatomy, the laparoscopic diagnosis and management of acute appendicitis is indicated in situs inversus.

Purpose: The aim of this study is to report a successful management of a sever nonspecific chronic low back pain relating to Visceral stiffness and altered respiratory pattern. Clinical Findings: A 33-year-old female with nonspecific low back pain, with abnormal Visceral stiffness, pain in the right abdominal side, pain and tenderness in areas of pelvic and respiratory diaphragms and inability in diaphragmatic breathing. Pain severity was reported as 10 based on VAS. MRI findings showed intervertebral disc protrusion at L5-S1 level. Diagnosis: Pain derived from Visceral spasms. Management: Four sessions of Visceral manipulation with diaphragmatic breathing exercises and general stretching exercises. Results: At the end of 1st session, the pain severity was improved for 80%, at the end of 2nd session the patient was able to perform perfect diaphragmatic breathing and pain severity was reported 3 based on Visual Analogue Scale (VAS). After 3rd session, pain was felt only at the time of wake up.

Background Dextrocardia is a malposition of the heart defined as the right-sided development of the heart. It can increase the likelihood of congenital heart defects or diseases (CHD) and the risk of related morbidities and mortalities. We aimed to determine the frequency of CHDs among Dextrocardia patients. Materials and Methods In a retrospective cross-sectional study the records of patients with Dextrocardia who referred to Imam Reza Hospital (tertiary referral center) of Mashhad between 2006 and 2016 were studied. Data were analyzed using SPSS software version 16. 0. Results In total 163 patients, 85 of whom (54%) were males were studied. Their mean age was 11. 41+ 0. 326 years. The frequency of major Dextrocardia subtypes were: situs inversus in 77 (47%), situs Solitus in 59 (36%), and situs ambiguous in 28 (17%) patients. The frequency of associated complex congenital heart defects (CHD) was 55% in situs inversus, 77% in situs solitus and 100% in situs ambiguous. Isolated associated CHD had a greater frequency in the situs inversus and situs solitus groups. The most common isolated associated CHD was septal defects. Conclusion More than 90% of all patients with Dextrocardia, had CHD whereas all patients with Dextrocardia and situs ambiguous had complex CHD.

When abdominal and thorasic organs are inversed it is called situs inversus and when most of the these organs are positioned abnormally and heterogenic It is called situs ambigus (Heterotoxy syndrome) which is a rare congenital defect (Incidence 1.44 in 100/000 live birth) In these, abnormal organs shift which could be to the Right side or left side (Right Isomerism, Left Isomerism). One of the Heterotoxy main subgroups is Right Isomerism, asplenia which is accompanied with centrally located liver, asplenia, two morphologic Right side lungs. Our case is 19 years old gril with central and peripheral cyanosis and clubbing from several years ago who had several recurrent pulmonary infection from childhood with history of PA banding surgery. She had dextrocardia, asplenia and cardiac abnormality were detected in CXR, echocardiography and sonography.Management of this abnormality include surgical correction and prevention of infection with vaccination and antibiotic prophylaxis due to asplenia.

Background: Dextrocardia is a congenital anomaly, which may have coexistent coronary artery disease (CAD), arrhythmias and conventional indications for device therapy.However, the implantation of transvenous leads can be technically challenging and the approach needs to be tailored to the patient's individual anatomy.Case presentation: A 54-year-old male with dextrocardia situs inversus and ischemic left ventricular dysfunction developed ventricular tachycardia and fibrillation. Therefore, leftsided approach, dual chamber implantable cardioverter-defibrillator (ICD) was applied using a conventional method and standard equipment after complete evaluation of cardiac anatomy and vascular assessment.Conclusion: Electrical device implantation in patients with dextrocardia is possible after obtaining complete information about anatomy and/or coexisting congenital abnormalities, which helps in obtaining appropriate implantation approach.

Sydenham Chorea (SC) is a childhood disease that most frequently occurs after infection with group A β-hemolytic streptococcus species. SC is the most commonly acquired childhood chorea, usually affecting 5 to 15-year-old children. Dextrocardia situs inversus refers to the heart being situated on the right side of the body. We found a case of SC with coexisting dextrocardia and situs inversus, which is rare to our knowledge. A 14-year-old girl was referred to Ali-Ibn-Abiltaleb Hospital due to choreoathetotic movements more in her upper than lower extremities, which impaired her usual function. Antistreptolysin O (ASO) titer was high. Her throat culture was positive for streptococci beta hemolytic. In cardiac study, moderate mitral regurgitation, tricuspid regurgitation, diastolic dysfunction, conus in the Right Ventricle Outlet (RVOT), rightsided aortic arch, dextrocardia, and situs inversus were reported. This was a rare case with SC that had such anomalies.

Background: Biliary atresia (BA) is a rare disease and the end result of a destructive inflammatory process in bile ducts, leading to fibrosis and liver cirrhosis. It has two forms: 1) syndromic or fetal or embryonic (10-35%) with various congenital anomalies, 2) non syndromic (70-90%), in which BA is an isolated anomaly. In this article we report on an infant with the first form of BA in which diagnosis and operation was not based on routine liver biopsy but on associated malformations and clinical features that were highly suggestive of embryonal form of biliary atresia. Case Presentation: A 70-day old infant with syndromic BA, levocardia, situs inversus and polysplenia. He developed jaundice in 4th day of life, liver was not palpable. Kasai operation was not effective. He developed liver cirrhosis at 3 months of age.Conclusion: Syndromic type of EHBA is a very rare disease with a worse outcome than non syndromic type of BA. Early diagnosis is important and may be difficult as the liver sometimes could not be palpable because of its malposition.