Acute Appendicitis in a Patient with Situs Inversus

Abstract

Purpose: Situs inversus is a rare developmental anatomic anomaly with a frequency of 1 in 10,000 live births. In patients with situs inversus, there is transposition of the viscera in the thoracic and/or abdominal cavity through the sagittal plane, creating a “mirror-image” from normal anatomy. Multiple other congenital abnormalities are common in patients with situs inversus including cardiovascular malformations, bronchiectasis, asplenia or polysplenia, and duodenal or esophageal atresia. Kartagener's syndrome is frequently found with dextrocardia and some form of situs inversus. Methods: Review of patient chart Results: A 42 year old male presented with 3 day history of diffuse abdominal pain which became localized to the periumbilical area. He also complained of nausea, vomiting, and loss of appetite. He has a history of abdominal situs inversus and colon cancer diagnosed at the age of 27. At presentation, he was afebrile, not tachycardic, and had a WBC of 10.6. A CT scan showed evidence of situs inversus viscerum and acute appendicitis with the appendix located inferior to the umbilicus. A laparoscopic appendectomy was performed without complication. The patient had a routine postoperative course and was discharged on postoperative day 1. Conclusion: Patients presenting with intra-abdominal pathology and situs inversus can present a challenge in diagnosis. Specifically, patients with left-sided appendicitis can present with left lower quadrant pain that can be interpreted as a different process, such as diverticulitis. When the presentation is not straightforward, a CT scan is invaluable as an aid in the diagnosis of the correct disease process as it will show evidence of situs inversus. Laparoscopy can also be useful in defining the anatomy in these difficult situations.