Gastric Cancer with Situs Inversus

A male patient, 71 years old, chronic smoker 30 pack years, has presented four months before his consultation, epigastric pain without vomiting or gastro-intestinal bleeding, evolving in a context of weakness with weight loss of 15 Kg in 4 months. Physical examination revealed an altered patient (WHO performance status 2), weighing 48 Kg, abdominal palpation found no abnormalities and examination of lymph nodes areas including supraclavicular was normal. The Esogastroduodenoscopy showed a vegetating tumor located in the gastric corpus and antrum, the biopsy concluded at a morphological and immunohistochemical aspect of gastric adenocarcinoma. The thoracic-abdominal-pelvic CT showed an incomplete situs inverus with a left liver, right stomach and right cecum, the inferior vena cava was located in the left side of the aorta (Figure A;B). The posterior corpus and fundus wall of the stomach showed diffuse thickening with presence of ascites and signs of peritoneal carcinomatosis without liver metastases and without deep abdominal lymphadenopathy. The chest organs were in their usual position. Ascites fluid cytology revealed neoplastic cells from glandular gastric origin. Due to the peritoneal carcinomatosis, only palliative chemotherapy was indicated