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

Abstract

Introduction and importance Left-sided acute appendicitis (LSAA) is a very rare cause of acute abdomen, developing in association with two types of congenital anomalies like as situs viscerum inversus (SVI) and midgut malrotation (MM). Preoperative diagnosis of LSAA is a challenge because of its rarity and atypical presentation. Imaging may be helpful for determining the correct diagnosis. Surgery represents the standard treatment of LSAA. Case presentation A 67-year-old Caucasian male with presented to the Emergency Department with a two-day history of left lower quadrant (LLQ) abdominal pain, nausea, vomiting, diarrhea and fever. Physical examination revealed LLQ abdominal rebound tenderness with guarding. Laboratory tests reported high levels of C-reactive protein and neutrophilic leukocytosis. Abdominal contrast-enhanced computed tomography showed a LSAA with intraluminal appendicoliths, fat infiltration and pericecal fluid collection in a patient with SVI. The patient underwent laparoscopic appendectomy: a gangrenous and perforated appendicitis was sectioned and removed with drainage of pericecal abscess. The postoperative course of the patient was uneventful. Clinical discussion LSAA is characterized by anatomical variation of appendix and atypical presentation. Preoperative clinical diagnosis of LSAA is very difficult and imaging may be helpful for determining the correct diagnosis, as well as confirming SVIT or MM. Laparoscopic appendectomy represents the correct treatment of LSAA. Conclusion LSAA is a rare surgical emergency that should be considered in the differential diagnosis of patients with LLQ abdominal pain. Preoperative diagnosis of LSAA needs a high index of suspicion and is facilitated by imaging. Surgery represents the appropriate treatment of LSAA.

Acute Appendicitis in Situs Inversus Totalis: A Case Report

“…Acute appendicitis is one of the common surgical conditions where patients require immediate surgical intervention to avoid complications of its perforation. Additionally, almost 4%-8% of all patients visiting emergency actually suffer from acute appendicitis [1]. Situs inversus totalis (SIT) is a rare reverse positional disorder of both thoracic and abdominal organs, with an incidence of 1 in 10,000-50,000 persons [2][3][4][5][6].…”

Subhepatic perforated acute appendicitis in a patient with midgut malrotation: A case report and review of the literature

“…The position of the appendix is extremely variable: the most common location is retrocecal (74%) followed pelvic (21%), subcecal (1.5%), preileal (1%), and postileal (0.5%) [9] . The appendix can also show atypical locations such as subhepatic, left-sided [2] , intraherniary [10] , lateral pouch, mesocolic and lumbar [11] . The first case of SHAA, due to non-descent of caecum, was first described in 1955 by King [12] .…”

“…Acute appendicitis (AA) represents a common surgical emergency, accounting for 4–8% of all emergency department visits [1] . Diagnosis of AA is usually relative simple and is based on clinical symptoms, physical examination and radiology, however the malposition or anatomical variation of the appendix make it uncertain and can delay the surgical treatment favoring the chances of appendiceal rupture and the onset of complications such as abscess formation or peritonitis [2] . Subhepatic acute appendicitis (SHAA), characterized by anatomical variation of appendix and atypical presentation, develops in association with two types of congenital anomalies like as midgut malrotation (MM) [3] and maldescent of the caecum [4] .…”

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 ).…”