Acute Appendicitis in Situs Inversus Totalis: A Case Report

Area of Science:

• Gastroenterology
• Surgical Innovation
• Medical Imaging

Background:

• Left-sided acute appendicitis (LSAA) is an uncommon presentation of appendicitis.
• It is frequently associated with congenital anomalies like situs inversus totalis (SIT) and midgut malrotation (MM).
• The atypical location and associated anomalies complicate diagnosis and increase the risk of perforation if not managed promptly.

Observation:

• A 36-year-old male with radiologically confirmed SIT presented with two days of left lower abdominal pain.
• Physical examination revealed minimal tenderness in the left iliac fossa.
• Abdominal ultrasonography and contrast-enhanced CT confirmed appendicitis in the presence of SIT.

Findings:

• Contrast-enhanced CT scans are vital for diagnosing LSAA, especially in patients with SIT or MM.
• Laparoscopic appendicectomy is the standard and effective treatment for LSAA.
• Diagnostic laparoscopy is a valuable option in cases of diagnostic uncertainty.

Implications:

• LSAA should be considered in the differential diagnosis for left-sided abdominal pain in patients with SIT or MM.
• Accurate radiological assessment is critical for timely diagnosis and management.
• Prompt surgical intervention, preferably laparoscopic, improves patient outcomes and reduces complications.