Case Report Coexisting Situs Inversus Totalis and Immune Thrombocytopenic Purpura Kemal Gundogdu, 1 Fatih Altintoprak, 2 Mustafa Yener UzunoLlu, 1 Enis Dikicier, 1 Esmail Zengin, 1 and Orhan YaLmurkaya 1 1 Department of General Surgery, Sakarya University Research and Educational Hospital, Sakarya, Turkey 2 Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey Correspondence should be addressed to Fatih Altintoprak; fatihaltintoprak@yahoo.com Received 3 December 2015; Accepted 12 January 2016 Academic Editor: Christoph Schmitz Copyright © 2016 Kemal Gundogdu et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Situs inversus totalis is a rare congenital abnormality with mirror symmetry of mediastinal and abdominal organs. Immune thrombocytopenic purpura is an autoimmune disease with destruction of thrombocytes. Tis paper is presentation of surgical approach to a case with coexistence of these two conditions. 1. Introduction Chronic immune thrombocytopenic purpura (ITP) is an autoimmune disease characterized by an immune response to thrombocyte membrane antigens. ITP is generally treated with surgery and steroids [1]. Situs inversus totalis is a rare congenital abnormality in which all of the mediastinal and abdominal organs are transposed to mirror symmetry of the normal anatomy. Tis paper reports the coexistence of these two rare conditions. 2. Case Presentation A 35-year-old woman was referred to our clinic with a diagnosis of ITP resistant to medical treatment in whom a splenectomy was indicated. For 7 years, she had been treated regularly with 1 mg/kg/day methylprednisolone and episodic intravenous immunoglobulin (IVIG) in the hema- tology clinic and had persistent thrombocytopenia of 3,000– 60,000/mm 3 , ongoing menorrhagia, and ecchymosis. Te patient had two healthy births afer IVIG treatment. Preop- eratively, dextrocardia was detected on an electrocardiogram and thoracoabdominal computed tomography (CT) showed situs inversus totalis. In addition to mirror imaging of the normal anatomic locations of all organs, the spleen measured 13 × 6 cm and there was a 1.5 cm accessory spleen in the right upper quadrant (Figure 1). Although no abnormalities were seen in the head and body of the pancreas, no pancreatic tail was seen. In other words, the pancreas had not crossed over to the right side of the superior mesenteric vascular axis and there was no pancreatic tissue near the splenic hilum (Figure 2). Te patient underwent a laparoscopic splenectomy (Figure 3) with no complications or adverse events following surgery. She was discharged on the third postoperative day with thrombocyte count of 155,000/mm 3 . 3. Discussion Immune (idiopathic) thrombocytopenic purpura is an autoimmune disease characterized by the destruction of thrombocytes or suppression of their production as a result of an immune reaction with thrombocyte membrane autoanti- gens [1]. Terapy is required when the thrombocyte count falls below 20,000/mm 3 or if there are symptoms such as mucosal or vaginal hemorrhage when the count is in the range 20,000–50,000/mm 3 . In the event of nonresponse to medical therapy, the alternative therapy is splenectomy [2]. Te treatment success rate afer splenectomy ranges within 50–70%. Accessory spleens are found in 15% of the general population and should be detected in ITP patients when a Hindawi Publishing Corporation Case Reports in Surgery Volume 2016, Article ID 8605673, 3 pages http://dx.doi.org/10.1155/2016/8605673