Right-sided acute appendicitis in situs inversus totalis. Case report
DOI:
https://doi.org/10.5281/Keywords:
Situs Inversus, AppendicitisAbstract
Background: Acute appendicitis is widely recognized as the prevailing abdominal surgical emergency globally, exhibiting an annual incidence ranging from 96.5 to 100 cases per 100,000 adults. Conversely, situs inversus totalis is a rare anatomical anomaly characterized by the complete reversal of the chest and abdominal organs, occurring in approximately 1 out of every 10,000 to 50,000 individuals.
Clinical case: 53-year-old female patient who presented to the emergency department with a complaint of diffuse abdominal pain of colic nature that had persisted for 5 days. The patient referred systemic hypertension, pre-diabetes mellitus type 2, and situs inversus as relevant medical history. A laparotomy procedure was conducted, revealing a perforated appendix located in the right hypochondrium. Additionally, the patient exhibited situs inversus totalis, with the colon positioned in its normal anatomical location.
Conclusions: Due to the low incidence of situs inversus totalis, in cases similar to the one presented, the utilization of image studies and laboratory studies is imperative for accurate diagnosis. In the face of diagnostic suspicions and inconclusive paraclinical studies, the most effective approach is to pursue surgical examination and intervention, preferably utilizing laparoscopic techniques.
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References
Moris D, Paulson EK, Pappas TN. Diagnosis and Management of Acute Appendicitis in Adults: A Review. JAMA. 2021;326(22):2299.
Di Buono G, Buscemi S, Galia M, et al. Acute appendicitis and situs viscerum inversus: radiological and surgical approach—a systematic review. Eur J Med Res. 2023 Feb 20;28(1):85.
Pipal DK, Pipal VR, Yadav S. Acute Appendicitis in Situs Inversus Totalis: A Case Report. Cureus. 2022;14(3):e22947. doi: 10.7759/cureus.22947.
Arraut-Gamez R, Gomez-Barrios J, Molinares-Pérez D, et al. Acute Appendicitis in Situs Inversus Totalis: A Case Report and Literature Review. Health Sci J. 2022;16(S7):950.
Zuluaga-Restrepo JD, Meza M. Apendicitis aguda en situs inversus totalis: reporte de un caso. Rev CES Med. 2012;26(2):209-14.
Eitler K, Bibok A, Telkes G. Situs inversus totalis: A clinical review. International Journal of General Medicine. 2022;15:2437-49. doi: 10.2147/IJGM.S295444.
Herrera Ortiz AF, Lacouture JC, Sandoval Medina D, et al. Acute cholecystitis in a patient with situs inversus totalis: An unexpected finding. Cureus. 2021;13(6):e15799. doi: 10.7759/cureus.15799.
Golash V. Laparoscopic management of acute appendicitis in situs inversus. J Minimal Access Surg. 2006;2(4):220.
Bertaud S, Badvie S. Contrary to expectation--a case of left-sided acute appendicitis. BMJ Case Rep. 2012;2012:bcr2012006552. doi: 10.1136/bcr-2012-006552.
Jones MW, Lopez RA, Deppen JG. Appendicitis. StatPearls Publishing. Treasure Island (FL): StatPearls Publishing; 2022. Disponible en: https://www.ncbi.nlm.nih.gov/books/NBK493193/
Huang SM, Yao CC, Tsai TP, et al. Acute appendicitis in situs inversus totalis. J Am Coll Surg. 2008;207(6):954. doi: 10.1016/j.jamcollsurg.2008.03.030.
Vettoretto N, Agresta F. A brief review of laparoscopic appendectomy: the issues and the evidence. Tech Coloproctol. 2011;15(1):1-6. doi: 10.1007/s10151-010-0656-2.
Kumar S, Jalan A, Patowary BN, et al. Laparoscopic appendectomy versus open appendectomy for acute appendicitis: A prospective comparative study. Kathmandu Univ Med J. 2016;14(55):244-8.
Liu Y, Cui Z, Zhang R. Laparoscopic versus open appendectomy for acute appendicitis in children. Indian Pediatr. 2017;54(11):938-41. doi: 10.1007/s13312-017-1186-z.
Partecke LI, von Bernstorff W, Karrasch A, et al. Unexpected findings on laparoscopy for suspected acute appendicitis: a pro for laparoscopic appendectomy as the standard procedure for acute appendicitis. Langenbecks Arch Surg. 2010;395(8):1069-76. doi: 10.1007/s00423-009-0567-8.
De Almeida Leite RM, Seo DJ, Gomez-Eslava B, et al. Nonoperative vs operative management of uncomplicated acute appendicitis: A systematic review and meta-analysis: A systematic review and meta-analysis. JAMA Surgery. 2022;157(9):828-34. doi: 10.1001/jamasurg.2022.2937.
Hoang TV, Hoang HT, Vo HT, et al. Laparoscopic appendectomy in an adult patient with situs inversus totalis. Journal of Surgical Case Reports. 2023(3):rjad134. doi: 10.1093/jscr/rjad134.
Aassouani F, Charifi Y, Hajjar C, et al. Left- sided appendicitis revealing a common mesentery: A Case Report. Radiology Case Reports. 2022;17(10):3718-21. doi: 10.1016/j.radcr.2022.07.009.
Evola G, Ferrara F, Di Fede GF, et al. Left-sided acute appendicitis in a patient with situs viscerum inversus totalis: A case report. International Journal of Surgery Case Reports. 2022;90:106658. doi: 10.1016/j.ijscr.2021.106658.
Di Buono G, Maienza E, Buscemi S, et al. Acute appendicitis in a patient with situs viscerum inversus totalis: Role of laparoscopic approach. A case report and brief literature review. International Journal of Surgery Case Reports. 2020;77S:S29-33. doi: 10.1016/j.ijscr.2020.10.047.
Cembraneli PN, Ambrogi G, Cavalcante JBF, et al. Acute appendicitis in patients with Kartagener syndrome. Case Reports in Surgery. 2020:8716474. doi: 10.1155/2020/8716474.
Otsuka Y, Hayashi R, Urano S, et al. Left-sided appendicitis due to situs inversus totalis. Clinical Case Reports. 2021;9(3):1791-2. doi: 10.1002/ccr3.3734.
Jackson ML, Shah SK, Agarwal AK. Acute Appendicitis in a Patient with Situs Inversus Totalis and Malrotation. CRSLS. e2019.00001. doi: 10.4293/CRSLS.2019.00001.
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