Laparoscopic appendectomy in an adult patient with situs inversus totalis

Abstract

Left-sided appendicitis is usually caused by situs inversus totalis or midgut malrotation. Clinical and imaging diagnoses have been presented relatively fully in the literature. However, this is a rare condition, and each related case should be further reported to help the day-to-day clinician better investigate and understand. Therefore, in this paper, we present a case of left-sided acute appendicitis in an adult male patient with situs inversus totalis. In addition, we also discuss the laparoscopic technique of the left-sided appendectomy as it is technically more difficult because of the mirror nature of the anatomy.

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.…”

“…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. Both were successfully managed with laparoscopic appendectomy.…”