Stomaco

Nella trasposizione completa dei visceri lo stomaco è situato sul lato destro.

Il restringimento congenito a clessidra dello stomaco è raro (46 dei 50 casi riportati riguardavano tuttavia donne).

Occasionalmente si osserva una stenosi congenita del piloro.

Può inoltre esservi un antro pilorico doppio o triplo, oppure l'antro può essere sostituito da un tubo a pareti ispessite.

Il fondo dello stomaco presenta talvolta un diverticolo.

Lo stomaco può essere parzialmente retroperitoneale (insieme alla milza e al lobo sinistro del fegato). Questa condizione si associa di norma a mesenteri e omenti difettosi.

Nella parete gastrica sono state riscontrate isole eterotopiche di tessuto pancreatico.

Il situs inversus ha un'incidenza di 1:4000 in Giappone, 1:5000 in Israele e 1:10.000-15.000 negli Stati Uniti e nell'Europa settentrionale. Il situs inversus fu riconosciuto da Fabricius nel 1600, quando descrisse un caso di fegato e milza invertiti. Petrius Servius nel 1615 descrisse una trasposizione totale dei visceri. Un'altra osservazione simile fu compiuta da Riolan nel 1668 in un caso relativo a un criminale giustiziato e, nella regina di Francia Maria de' Medici (1573-1642), si ebbe ancora un altro caso autenticato (Beck). Kuchenmeister nel 1824 riconobbe per la prima volta il situs inversus in una persona vivente. LeWald dimostrò la difficoltà di ottenere statistiche attendibili sul situs inversus. LeWald riferisce che all'esame obiettivo la frequenza riportata è di 1/35.000, in sala settoria 1/10.000, all'esame autoptico 1/5.000 e all'esame radiologico 1/1.400.

In uno studio su 18.480 pazienti operati, 25 bambini e quattro adulti presentavano variazioni della posizione dei visceri addominali. In 15 casi vi era una completa assenza di rotazione intestinale, in tre casi una rotazione incompleta, in nove casi una rotazione anomala e in due casi un situs inversus. Il situs inversus è stato associato, sul piano dello sviluppo, a ciglia immobili (Afzelius, 1976) ed è trasmesso come carattere autosomico recessivo (sindrome di Kartagener). Ciglia immobili con conseguente sterilità e bronchite cronica possono accompagnare il situs inversus.

Situs inversus (trasposizione dei visceri)

Riferimenti dell’opera originale

Elenco riportato come compare nella fonte, senza normalizzazione dei formati bibliografici. Le voci non sono tradotte: un riferimento bibliografico si cita nella lingua in cui è pubblicato.

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