Acute Appendicitis in Situs Inversus Totalis: A Case Report

Abstract

Left-sided acute appendicitis (LSAA) is a rare cause of acute pain in the abdomen and is associated with developmental anomalies such as situs inversus (viscus) totalis (SIT) and midgut malrotation (MM). Due to the rarity along with the atypical presentation, diagnosis of LSAA is difficult, and if it is not managed timely, complications of appendicitis such as perforation can result. Imaging including contrast-enhanced CT scans and ultrasound aids in establishing the diagnosis. In case of a diagnostic dilemma, a diagnostic laparoscopy is an optimal option that offers diagnostic as well as therapeutic benefits. Operative intervention, preferably laparoscopic, is the standard treatment of LSAA. We report a case of appendicitis in a 36-year-old man with SIT detected radiologically who presented with pain in the left side of the lower abdomen for two days. Minimal tenderness was noted on the left iliac fossa during per abdominal examination. Abdominal ultrasonography was showing probe tenderness in the left iliac fossa, and contrast CT of the abdomen was suggestive of appendicitis with SIT. The patient was managed by laparoscopic appendicectomy. Therefore, we conclude that LSAA should be listed in the differentials of the various causes of left-sided pain in patients with SIT or MM. Clinical diagnosis is often difficult, and CT scan is crucial to establish the diagnosis as well as confirm rotational anomalies. Surgery, preferably laparoscopic, represents the appropriate treatment of LSAA.

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

“…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 ].…”

“…This is especially relevant given the growing body of case reports [ 2 ] on acute appendicitis in patients with SIT. In addition, our study also contributes to the literature on adaptations such as ideal port placements for laparoscopy triangulation, resection/ligation of the mesoappendix, and monitor placement on the left instead of the right of the patient with the surgeon on the right [ 12 , 14 , 15 ]. This placement may be required for the procedural convenience of the surgeon during laparoscopic appendectomy for left-sided acute appendicitis.…”

“…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.…”

Left-sided acute appendicitis in a patient with situs inversus totalis: A case report and a comprehensive review

“…CT scan and US were also done in our case and the findings were consistent with that of the literature. Although laparoscopic appendectomy is challenging in these cases, it is still the standard approach for management [1] . The advantages of this technique are rapid postoperative recovery, shorter hospital stay, less surgical stress, and lower postoperative complications [16] .…”

“…AA is a frequent surgical condition that demands urgent intervention [1] . It accounts for approximately 6% of all emergency department visits [2] .…”