Incidental diagnosis of situs inversus totalis: a perspective from an emergency department attendance

Abstract

A 30-year-old man of African origin presented to our emergency department (ED) with subjective fever and abdominal pain which started on the day of attendance. Vital signs and systemical examination were within normal limits. As part of his evaluation in ED, a 12-lead electrocardiogram was performed which showed features consistent with dextrocardia later confirmed on a chest X-ray as well. An ultrasound scan of the abdomen was performed which showed mirror imaging of the abdominal viscera, all of which were otherwise structurally normal. A diagnosis of situs inversus totalis was made. The patient’s symptoms resolved with analgesia and he was discharged with advice to follow-up in our hospital’s outpatient department. The diagnosis of situs inversus in the ED is a tricky one to make and most cases of this condition are discovered incidentally, as in our case. The mirror-imaged arrangement of viscera can have implications on the site of localised complaints, the physical examination, future health problems for the patient including anaesthesia risks, chronic lung conditions, cardiac complications and specialised trauma management. This anatomical variation can pose diagnostic challenges in such patients. Based on meticulous examination and readily accessible investigations including X-rays, 12-lead ECG and ultrasound, a timely diagnosis can be made.

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

“…For patients with postprandial left upper abdominal pain, physical examination is needed to reveal a heartbeat in the right hemithorax and hepatic dullness in the left upper abdomen so that cholelithiasis associated with SI can be considered in addition to acute myocardial infarction or a peptic ulcer. In patients with uncertain features, a careful physical examination with radiological investigations plays a significant role in SI diagnosis[ 36 , 37 ]. Here, we propose a practical algorithm for the diagnosis and management of cholelithiasis and choledocholithiasis in SI patients (Figure 4 ).…”