Talk:Paper - A subject with complete transposition of viscera (1917)

- A SUBJECT WITH COMPLETE TRANSPOSITION OF VISCERA. By M. Amin ABDEL RauMan, Assistant Professor of Anatomy, Cairo.

THE body was that of a typical old Egyptian male, between 85 and 90 years of age, very well developed, and without any external signs of disease. On opening the body on its ventral aspect we found the following conditions :—

1. Thorax.

(a) Right subclavian vein and right jugular united to form the right innominate, which was found passing downwards and to the left to meet the left innominate on the left side of the ascending aorta, to form the superior vena cava. As the right innominate vein passed to the left it crossed the arch of the aorta with the commencement of the subclavian, carotid, and innominate arteries, in that order from right to left.

(b) Heart.—On opening the pericardium, the heart was found lying in position with its apex pointing downwards, forwards, and to the right, instead of to the left. From the base of the heart the vessels were found arising in the following order :—

Pulmonary artery—Arising from the left ventricular chamber, then going upwards and to the right, where it was found bifurcating under the arch of the aorta.

Aorta.—Arising from the right ventricular chamber and going upwards and slightly to the left, this was then directed upwards, backwards, and to the right in an arched manner, becoming continuous with the descending thoracic aorta that was found lying on the right side of the vertebral column. The vessels arising from the convexity of the arch were found, as already mentioned, to be, from right to left, the right subclavian, right carotid, and innominate ; this last bifurcated at the left side of the root of the neck into left carotid and subclavian. The right vagus was found crossing the arch superficially, and giving in its concavity its recurrent branch, which looped below the arch and then went upwards to the right side of the larynx.

The auricle situated on the left side of the heart received from above the superior vena cava and from below the inferior vena cava. Its A Subject with Complete Transposition of Viscera 305

appendix was seen to a great extent from the front, overlapping the origins of the two great arteries.

The vena azygos major arched over the root of the left lung and opened into the superior vena cava.

The ventricle of the left side was found to have a very much thinner wall than the corresponding right chamber; it gave origin to the pulmonary artery, and communicated with its auricle by the tricuspid opening. This chamber occupied more than half of the anterior surface of the heart.

The ventricle on the right side had much ‘thicker walls, about '23 mm. thick. It gave origin to the aorta, and communicated with its auricle by the mitral opening. This chamber occupied less than half of the anterior surface of the heart.

The auricle on the right side received the four pulmonary veins, coming from both lungs. Its appendix was hardly seen from the front of the heart.

(c) Lungs.—It was difficult to find the three fissures in either the right or left lung, but the left one was shorter and broader than the right.

(d) The descending aorta passed down on the right of the vertebral column and cesophagus, behind the root of the right lung and pericardium.

2. Abdomen.

The diver was found lying with its larger lobe and gall-bladder on the left side of the body, while the smaller lobe was on the right. The notch on the posterior surface for the cesophagus was to the right side of the middle line of the body, while that for the inferior vena cava was on the left. The round ligament passed towards the left from the navel, and disappeared in the fissure between the two lobes (fig. 1: 5). :

Stomach.—The cardiac opening, fundus, and body were found lying in the right side of the abdomen; the pylorus, directed to the left, lay under the large lobe of the liver. The lesser curvature was directed from right to left and downwards, as was also the great curvature.

The spleen was found lying behind and to the right side of the fundus of the stomach, in the right hypochondriac region (fig. 1: 8).

Duodenum.—Began at the pylorus on the left side of the abdomen, and had the convexity of the second portion directed to the left. Its third part passed from left to right, crossing first the inferior vena cava and then the aorta, and ended on the right at the level of the 2nd lumbar vertebra, where it became continuous with the jejunum.

The pancreas had ‘its head directed to the left, lying in the concavity 306 Mr M. Amin Abdel Rahman

of the duodenum, whilst its tail lay on the right side, abutting against the hilum of the spleen.

- The cecwm and appendix were found in the left iliac fossa, with the appendix hanging into the cavity of the true pelvis (fig. 1: 18, 14).

Fic. 1.—From a photograph of the case here described,

1, aorta;!2, superior vena cava; 3, “left” lobe of liver; 4, “right”’ lobe; 5, round ligament ; 6, cardiac part of stomach ; 7, pyloric part.; 8, spleen ; 9, tail of pancreas ; 10, inferior mesenteric vein ; 11, superior mesenteric vessels ; 12, inferior vena cava; 13, cecum ; 14, appendix ; 15, pelvic colon.

Colon.—The ascending part lay in the left side of the abdomen. The’ transverse colén began on the left, under the larger lobe of the liver, and ended on the right, under the spleen; from this the descending colon passed down on the right side of the abdomen to be continuous with the pelvic colon (fig. 1: 15).

The kidneys were both on the same level.

The aorta descended slightly to the right of the middle line and biA Subject with Complete Transposition of Wiadsrd” 307

furcated into the common iliac arteries at the level of the 4th lumbar vertebra. Its branches :—

The gastric artery passed to the right and, after reaching the cardiac end of the stomach, followed the small curvature.

The splenic artery was directed to the right, ending in the hilum of the spleen. . .

The superior mesenteric artery passed downwards, forming a curve with its concavity to the left. The inferior mesenteric artery, taking origin from the right side of the aorta, crossed the right common iliac to become continuous with the superior hemorrhoidal artery.

Inferior vena cava.—Formed on the left side of the body of the 5th lumbar vertebra by union of the two common iliac veins, the right vein crossing to the left. It then ascended on the left of the aorta, passing behind the third and second portions of duodenum and liver, to end in the left auricle after piercing the left side of the central tendon of the diaphragm.

The left spermatic vein ended in the left side of the vena cava itself, while the right vein ended in the right renal vein.

The right renal vein crossed superficial to the aorta to reach the vena cava, so was longer than the left.

The inferior mesenteric vein was found ascending on the right side af the abdomen and then crossing to the left at the level of the hilum of the right kidney, then crossing behind duodeno-jejunal flexure, passing superficial to the superior mesenteric artery, and then terminating in the superior mesenteric vein near its junction with the splenic.

The swperior mesenteric vein was found on the left side of the corresponding artery, ascending to join the splenic vein, thus forming the portal vein on the left side of the middle line.

Mesentery proper.—The attached border of this was found fixed above to the right side cf the body of the 2nd lumbar vertebra; it then passed downwards and to the left, ending in the region of the cecum in the left iliac fossa.

The specimen was kept and preserved in gelatin jelly, after being injected in the usual manner with formalin solution.