內臟位置異常：側畸症病例報告

Situs Anomalies: A Case Report of Situs Ambiguous

內臟位置異常的特徵包括腹腔及胸腔內器官位置改變，這是一個罕見的先天異常，發生率大約從1/4,000到1/20,000。進一步的分類為單獨右心症、內臟異位合併左心症、內臟異位合併右心症（也稱為完全性內臟異位）及側畸症。本文報告一位過去病史有胃潰瘍及胃食道逆流的12歲女孩，因上腹痛合併解血便而意外發現有側畸症。病人胸部X光檢查發現右側橫膈膜下有胃的氣體；腹部電腦斷層掃描發現病人的胃、脾臟及膽囊在右側腹腔，肝臟在兩側腹腔皆有，而左側腹腔肝臟較大。由上述影像學檢查意外發現病人為內臟位置異常中的側畸症。病人住院治療7天，經一系列檢查後，除內臟異位外並無其他相關之先天性心臟病及無脾症等嚴重病症，於臨床症狀明顯改善後出院。

Situs anomalies are characterized by the transposition of abdominal and thoracic viscera and vascular organs. It is a rare congenital anomaly, with an incidence varying from between 1/4,000~1/20,000 live births. It can be classified into isolated dextrocardia, situs inversus with levocardia, situs inversus with dextrocardia (so-called situs inversus totalis) and situs ambiguous. We report a case of unexpectedly discovered situs ambiguous. The patient was a 12-yearold girl who had a history of peptic ulcer and gastroesophageal reflux disease and presented with epigastric pain and bloody stool. Her chest X-ray showed gastric gas below the right diaphragm; abdominal computed tomography showed that her stomach, spleen and gallbladder were on the right side of the abdomen; however, her liver was over the midline, mainly on the left side. According to the aforementioned image findings, this patient was diagnosed with situs ambiguous. No other severe diseases such as congenital heart disease or asplenia were found after a series of examinations. She was hospitalized for seven days, and discharged when her clinical symptoms improved significantly.