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

Abstract

Situs inversus totalis (SIT) is a rare congenital anomaly involving mirror-image reversal of thoracic and abdominal organs, which may complicate the diagnosis and management of acute abdominal conditions due to atypical symptom localization. This report describes a 23-year-old male who presented with lower abdominal pain and vomiting. Clinical examination revealed tenderness in the left iliac fossa and laboratory findings showed leukocytosis. A chest X-ray revealed dextrocardia, raising suspicion for situs inversus totalis, which was confirmed by contrast-enhanced CT demonstrating an inflamed appendix in the left iliac fossa. The patient underwent laparoscopic appendectomy with modifications to port placement and operative positioning to accommodate the reversed anatomy. The procedure was completed without complication, and the patient recovered uneventfully. This case highlights the importance of early recognition of anatomical anomalies in patients with atypical abdominal pain and supports the use of laparoscopy as both a diagnostic and therapeutic approach in SIT.

Keywords: acute abdomen; atypical abdominal pain; diagnostic challenge; laparoscopic appendectomy; left-sided appendicitis; situs inversus totalis.

Figure 1

Coronal (left) and axial (right) CT images of the abdomen demonstrating situs inversus totalis with the liver located on the left side and spleen on the right. The inflamed appendix is seen in the left iliac fossa, with mural thickening and a visible appendicolith (arrow), consistent with acute appendicitis.

Figure 2

Schematic illustration of mirror-image port placement for laparoscopic appendectomy in a patient with situs inversus totalis. Three ports were used: a 10 mm camera port at the umbilicus, a 10 mm working port in the right lower quadrant (mirror of standard left-sided placement), and a 5 mm assistant port in the supra-pubic area. The operating surgeon and assistant stood on the patient's right side, with the monitor positioned to the left.

Figure 3

Intraoperative image of inflamed appendix in the left iliac fossa.