Left-sided Acute Appendicitis in a Case of Situs Inversus Totalis

The displacement of all thoracic and abdominal organs is called situs inversus totalis (SIT). Its incidence is 0.01% and it is characterized by abnormal anatomy but normal organ functions. It is a benign condition with a normal life expectancy and an asymptomatic course. Situs inversus; causes difficulties in the diagnosis and treatment of all internal organ pathologies. Having detailed information about human structure and anatomical variations is of great importance in daily clinical practice and particularly in emergency medical interventions and surgeries. Anatomical variations can be fatal in routine patient evaluations and emergency interventional procedures. Acute appendicitis is the most common pathology requiring emergency surgery and constitutes 4%-8% of all emergency department admissions. Although it can be easily diagnosed by clinical examination without the need for imaging studies due to typical symptoms such as pain migration, there is difficulty in definitive diagnosis in patients with anatomical variations such as SIT. The symmetrical localization of the appendix in situs inversus cases causes acute appendicitis to be included in the differential diagnosis of left lower quadrant pain. The differential diagnosis of left lower quadrant appendix vermiformis with gynecopathology, such as ovarian cyst rupture, causes more difficulties in female patients with SIT. The differential diagnosis of left lower quadrant pain is more difficult in women than in male patients. SIT is mostly diagnosed incidentally. The different anatomical location of the organs from normal healthy individuals causes the patient management to take a very careful situation in the applications of patients with situs inversus in cases requiring emergency intervention. When these patients present to the emergency department with acute abdomen findings, both the diagnosis and consultation process to the necessary branches should be clearer than other patients. A definitive diagnosis should be avoided without clarification of organ localization.

Keywords: Situs inversus totalis, acute appendicitis, left-sided appendicitis, ovarian cyst