Left-sided appendicitis in a patient with situs inversus totalis

Abstract

Situs inversus totalis is a rare inherent disease in which the thoracic and abdominal organs are transposed. Symptoms of appendicitis in situs inversus (SI) may appear in the left lower quadrant, and the diagnosis of appendicitis is very difficult. We report a case of left-sided appendicitis diagnosed preoperatively after dextrocardia that was detected by chest X-ray, although the chief complaint of the patient was left lower-quadrant pain. The patient underwent an emergent laparoscopic appendectomy under the diagnosis of appendicitis after abdominal computed tomography (CT). In patients with left lower quadrant pain, if the chest X-ray shows dextrocardia, one should suspect left-sided appendicitis. A strong suspicion of appendicitis and an emergency laparoscopic operation after confirmation of the diagnosis by imaging modalities including abdominal CT or sonography can reduce the likelihood of misdiagnosis and complications including perforation and abscess. Laparoscopic appendectomy in SI was technically more challenging because of the mirror nature of the anatomy.

Dextrocardia and Situs Inversus with Incomplete Inversion: a Case Report

“…It has been stated that multiple molecules or genes determine laterality and act in a region-or organ-specific manner [10]. Several studies reported about situs inversus totalis that all thoracic and abdominal viscera were completely transposed [2,4,8,[11][12][13][14][15][16]. However, Mano et al (2006) [17] reported that situs inversus with unclearly inverted morphology, neutral laterality (i.e.…”

Acute Appendicitis in Patients with Kartagener Syndrome

“…Since pain located in the left iliac fossa resulting from acute appendicitis is extremely rare, it may be related to congenital abnormalities such as intestinal malrotation or SIT [10]. This symptom may delay the diagnosis, because other possibilities are more likely diverticulitis, renal colic, ruptured ovarian cyst, Meckel's diverticulitis, epididymitis, prostatitis, intestinal obstruction, incarcerated hernia, enteritis, pelvic inflammatory disease, and mesenteric ischemia [11]. A delayed diagnosis increases the risk of complications such as perforation [12].…”

Single-Incision Multi-Port Appendectomy for a Patient with Situs Inversus Totalis: First case report

“…8 Disconcertingly, up to 15% of SIT patients with appendicitis report pain on the right side. 3 A small proportion of those without neural situs inversus complain of appendicular pain on the right side as well. 5,7,9,10 This anomaly occurs due to a failure in the transposition of the nervous system, with the leftsided appendix still causing right iliac fossa pain.…”