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Review
. 2021 Jul-Sep;62(3):861-867.
doi: 10.47162/RJME.62.3.27.

A rare case of situs inversus totalis associated with sigmoid diverticulitis and appendicular agenesis. Embryological, clinical considerations and literature review

Alin Florin Miheţiu  1 , Dan Georgian Bratu, Oana Maria Popescu, Ciprian Juravle, Iulia Emanuela Dumitrean, Radu Chicea
Affiliations
Review

A rare case of situs inversus totalis associated with sigmoid diverticulitis and appendicular agenesis. Embryological, clinical considerations and literature review

Alin Florin Miheţiu et al. Rom J Morphol Embryol. 2021 Jul-Sep.

Abstract

The revelation of situs inversus totalis by a peritoneal syndrome is an extremely rare event. The association of this condition with sigmoid diverticulitis and agenesis of the vermiform appendix has not been described in the literature. This paper aims to present the first case of this type while screening the literature on this topic. The authors present the case of a sigmoid diverticulitis associated with situs inversus totalis and agenesis of the vermiform appendix, in a 44-year-old male patient. Because of abdominal pain located in the right iliac fossa, elevated temperature (38.2°C) and biological examinations, acute appendicitis was rather simulated and considered as a presumptive diagnosis. Diagnostic accuracy was achieved during laparoscopic exploration of the peritoneal cavity, which proved the coexistence of visceral transposition, appendiceal agenesis and sigmoid diverticulitis, usually noted as a rare finding. Secondly, we performed a systematic search on PubMed® and Google Scholar® databases introducing the following terms: situs inversus totalis, acute appendicitis. Given the time span of the last 30 years, we have obtained a small number of cases in which symptoms that are specific to acute appendicitis have been found in patients with situs inversus totalis. Due to the rare number of cases, it is difficult to establish a preoperative diagnosis. Usually, this diagnosis is revealed as an intraoperative surprise. A careful clinical examination and a set of standardized paraclinical examinations can guide the diagnosis. The patient's evolution was favorable, without any other changes at the subsequent examinations.

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Conflict of interest statement

The authors declare no conflict of interests.

Figures

Figure 1
Figure 1
Right iliac fossa with sigmoid diverticulitis
Figure 2
Figure 2
Left iliac fossa with cecum and appendix agenesis
Figure 3
Figure 3
CT scan image of the thorax: dextrocardia. CT: Computed tomography
Figure 4
Figure 4
Abnormal placement of stomach and liver
Figure 5
Figure 5
Cecum, appendix agenesis
See this image and copyright information in PMC

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