A rare case of situs inversus totalis associated with sigmoid diverticulitis and appendicular agenesis. Embryological, clinical considerations and literature review

Miheţiu, Alin; Bratu, Dan; Popescu, Oana Maria; Juravle, Ciprian; Dumitrean, Iulia Emanuela; Chicea, Radu

doi:10.47162/rjme.62.3.27

Cited by 5 publications

(4 citation statements)

References 38 publications

(43 reference statements)

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“…In line with earlier research [ 10 , 12 , 13 , 15 , 16 ], SIT and left-sided non-perforated acute appendicitis were diagnosed by chance encounter in our patient and successfully managed by laparoscopic appendectomy, without complications. Only 1 case report noted a patient aware of his SIT during the presentation to the Emergency Department with left lower quadrant abdominal pain [ 14 ].…”

Section: Discussionsupporting

confidence: 89%

“…Appendectomy is among the most commonly reported surgical procedures in patients with SIT [ 9 – 11 ], followed by cholecystectomy, gastrectomy, and colorectal resections [ 3 ]. Several case reports have documented successful management of left-sided acute appendicitis with laparoscopic appendectomy [ 10 , 12 – 15 ]. For instance, 2 recent reports by Hoang et al [ 15 ] and Abdulla et al [ 13 ] described left-sided acute appendicitis in a 42-year-old man and a 65-year-old man, respectively, with previously undiagnosed SIT.…”

Section: Introductionmentioning

confidence: 99%

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A Case of Left-Sided Acute Appendicitis in a 45-Year-Old Man with Situs Inversus Totalis Managed by Emergent Laparoscopic Appendectomy

Mvoula,

Khrisat,

Lueders

2024

Am J Case Rep

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Patient: Male, 45-year-old Final Diagnosis: Acute appendicitis – left sided Symptoms: Left lower quadrant abdominal pain • nausea • non bilious non bloody emesis Clinical Procedure: Laparoscopic appendicectomy Specialty: Surgery Objective: Congenital defects/diseases Background: Situs inversus totalis (SIT) is a rare congenital abnormality that includes mirror-image transposition of both the abdominal and the thoracic organs. It may remain undetected into adulthood until an acute medical emergency results in diagnostic imaging. This report presents a challenging case of left-sided acute appendicitis in a 45-year-old man with SIT. Case Report: A 45-year-old man with a medical history of gastroesophageal reflux disease, class 2 obesity, prediabetes, and elevated low-density lipoprotein cholesterol presented with severe acute abdominal pain localized in the left lower quadrant with localized tenderness, nausea, and 2 episodes of non-bloody and non-bilious emesis that started a day before the clinical encounter. Computed tomography of the abdomen and pelvis revealed previously undiagnosed congenital SIT. In addition, physical, laboratory, and radiological findings suggested early acute appendicitis with no evidence of complications. Hence, the patient was managed with an emergent laparoscopic appendectomy. Acute appendicitis was confirmed in the post-surgery histopathological examination. The post-surgery recovery was uneventful, and the patient was discharged home on the second postoperative day. Conclusions: This report highlights that SIT may remain undiagnosed into adulthood and poses a challenge in the diagnosis of left-side appendicitis due to atypical symptom presentation, supporting the findings of previous case reports. Therefore, the inclusion of left-sided acute appendicitis in the differential diagnosis of abdominal pain in the left lower quadrant is warranted.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

A Case of Left-Sided Acute Appendicitis in a 45-Year-Old Man with Situs Inversus Totalis Managed by Emergent Laparoscopic Appendectomy

Mvoula,

Khrisat,

Lueders

2024

Am J Case Rep

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“…In our case, duplication of the right ureter and abnormal insertion of the distal CBD into the 3 rd portion of the duodenum were found on CT (Figures 1 and 3C ). Although their association with SI remains unclear[ 32 , 33 ], we should always pay attention to SI patients to identify possible anomalies in preoperative surveys.…”

Section: Acute Biliary Tract Disease In Situs Inversus Patientsmentioning

confidence: 99%

Laparoscopic common bile duct exploration to treat choledocholithiasis in situs inversus patients: A technical review

Chiu¹,

Chuang²,

Chuang³

et al. 2023

World J Clin Cases

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Situs inversus (SI) is a rare congenital condition characterized by a mirror-image transposition of the major visceral organs. Since the 1990s, more than one hundred SI patients have been reported to have successfully undergone laparoscopic cholecystectomy. In these cases, the major problem is to overcome is the left-right condition for right-handed surgeons. Laparoscopic common bile duct exploration (LCBDE), an alternative to treat patients with bile duct stones, has shown equivalent efficacy and is less likely to cause pancreatitis than endoscopic retrograde cholangiopancreatography. Recent updated meta-analyses revealed that a shorter postoperative hospital stay, fewer procedural interventions, cost-effectiveness, a higher stone clearance rate, and fewer perioperative complications are additional advantages of LCBDE. However, the technique is technically demanding, even for skilled laparoscopic surgeons. Conducting LCBDE in patients with difficult situations, such as SI, is more complex than usual. We herein review published SI patients with choledocholithiasis treated by LCBDE, including our own experience, and this paper focuses on the technical aspects.

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“…However, due to the small number of cases, most surgeons have no surgical experience in this type of disease, which makes the operation difficult. Most of the treatment for this type of operation is mainly reflected in the removal of the gallbladder and appendix ( 2 , 3 ). Looking back over the past few decades, there are very few reports on the surgical treatment of patients with total inverse gastric cancer.…”

Section: Introductionmentioning

confidence: 99%

Case report: Laparoscopic-assisted distal gastrectomy for gastric cancer in a patient with situs inversus totalis

Zhu

Hu²,

Sun³

2023

Front. Surg.

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BackgroundSitus inversus totalis (SIT) is a rare congenital disease with a series of clinical features characterized by a mirror image distribution of the viscera to the normal anatomy.Case presentationThis study aims to report a 63-year-old male SIT patient with gastric cancer with a preoperative diagnosis of stage IIB gastric cancer (cT3N0M0), who underwent a preoperative multi-disciplinary treatment (MDT) discussion and an abdominal enhancement CT for visceral evaluation to ensure a successful operation. A laparoscopic-assisted distal gastrectomy including D2 lymph node dissection and Billroth I reconstruction was successfully performed. Laparoscopic radical gastric gastrectomy and D2 lymph node dissection were performed through the opposite surgical station to the conventional one, followed by digestive tract reconstruction under small incision-assisted direct vision. There was less blood loss throughout the operation, no postoperative complications, and the patient was discharged successfully 10 days after surgery. Histopathological examination showed ulcerated high-medium differentiated adenocarcinoma stage IB (PT2N0M0). There were no complications or tumor recurrence in the patient with examination 6 months after the operation.ConclusionSurgery in a patient with gastric cancer and SIT can be safely performed by the application of 3D laparoscopy and small incisions to assist the digestive tract reconstruction under direct vision.

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A rare case of situs inversus totalis associated with sigmoid diverticulitis and appendicular agenesis. Embryological, clinical considerations and literature review

Cited by 5 publications

References 38 publications

A Case of Left-Sided Acute Appendicitis in a 45-Year-Old Man with Situs Inversus Totalis Managed by Emergent Laparoscopic Appendectomy

A Case of Left-Sided Acute Appendicitis in a 45-Year-Old Man with Situs Inversus Totalis Managed by Emergent Laparoscopic Appendectomy

Laparoscopic common bile duct exploration to treat choledocholithiasis in situs inversus patients: A technical review

Case report: Laparoscopic-assisted distal gastrectomy for gastric cancer in a patient with situs inversus totalis

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