Times of India
07 October 2010
By Sumitra Deb Roy
Mumbai, India

Kandivli resident Prabha Goyal (45) is oblivious to the fact that she is possibly one of the few persons in the world to have successfully undergone a liver transplant despite the organ being on the reverse side of her body.

Two weeks back, when she was reeled inside the operation theatre of Apollo Hospital, Delhi, for a liver transplant, the challenges before the doctors were galore. Her liver had stopped functioning completely and the transplant was her only shot at life. The bigger challenge though was that she was suffering from an uncommon congenital condition called situs inversus, which meant that all her chest and abdominal organs were transpositioned, or in completely reverse positions.

It was only a few years ago when she had to visit a city cardiologist to seek treatment for an unexplained pain in the right side of her chest that she came to know of her unusual health condition.

The doctor broke the news to Prabha’s husband Rajendra that her heart was on the right side of the body. And, this was not it. Her liver, lung lobes, spleen, appendix too were placed on the reverse sides. But things were fine, till her swollen legs indicated that she was suffering from end–stage liver failure. "I was told liver transplant was the only option left for her," said Rajendra. But surgeons said since her liver was on the left side of her body instead of the right, it was a complicated option.

"We chose to go to Delhi given that city’s success rate in these surgeries," he said. Prabha’s 22–year–old daughter chose to become the donor after Rajendra’s blood group did not match that of his wife.

The surgery that took place two weeks back lasted for about 12 hours. Liver surgeon at Apollo Hospital, Dr Subhash Gupta, said there were many technical difficulties in fitting the new liver. "A structure which originally belonged to the right side of the body had to be fitted on the left side," he said, adding, "All structures associated with the organ had to be reconnected after her native liver was removed."

Gupta said that the donor’s liver had to be rotated a full 180 degrees in order to fit Prabha’s liver on the left side of the body. "It was a challenge as we had to keep calculating how the donor liver will fit in her chamber. We had to reverse it and make six new vessel connections so that the liver can start functioning normally," he said.

Gupta said the different positioning of vessels and ducts added to the complications. "But she is fine now and will return to Mumbai and normal life soon," he added.

Reverse Placement Situs Inversus is a congenital condition where there is complete mirror image reversal of chest and abdominal organs Known to affect one in 8,500 people, about 3–5% patients can have functional heart defects The heart that typically lies on the left side of the body, is found on the right; liver and spleen that normally lie on the right are on the left Normally, lung on the left has two lobes and lung on the right has three lobes but in this condition it becomes exactly opposite

Liver Transplant For Situs Inversus Patient
Considered an absolute contraindication to liver transplantation due to technical difficulties Deformity of vessels and vague anatomy makes transplant complicated Less than 5 people in the world are believed to have successfully undergone the surgery Placement of vessels and bile ducts are different and extra effort has to be taken to fit the donor liver Donor liver has to be rotated 90 degrees or 180 degrees to fit the patient appropriately