Introduction: Left-sided acute appendicitis (LSAA) develops in association with two
types of congenital anomalies: situs inversus totalis (SIT) and midgut
malrotation (MM). A Left sided appendicitis is an ambiguous and difficult
diagnosis to make. Aim: To present a proven case of left-sided acute
appendicitis (LSAA) associated with situs inversus totalis (SIT). CaseReport: A case of Left appendicitis was evaluated in a 28-year-old Asian male, who
presented to our hospital in Feb. 2016,
with lower abdominal pain more on left side and suspected diverticulitis or
acute appendicitis with unusual appendix location. The patient doesn’t recall
any history of abdominal surgery or about situs inversus totalis, abdominal and
pelvic ultrasound was done, left iliac fossa appendicitis was diagnosed, Erect
chest X-ray including upper abdomen revealed dextrocardia and stomach air on
right side (situs inversus totalis), the patient underwent diagnostic Laproscop
and Endoscopic resection of the appendix, with no incidents, and then
discharged without complications, follow visits went unremarkable. Conclusion: The diagnosis of left lower quadrant pain is based on well-established
clinical symptoms, physical examination and physician’s experience.
References
[1]
Akbulut, S., Caliskan, A., Ekin, A. and Yagmur, Y. (2010) Left-Sided Acute Appendicitis with Situs Inversus Totalis: Review of 63 Published Cases and Report of Two Cases. Journal of Gastrointestinal Surgery, 14, 1422-1428.
https://doi.org/10.1007/s11605-010-1210-2
[2]
Hou, S.K., Chern, C.H., How, C.K., Kao, W.F., Chen, J.D., Wang, L.M. and Huang, C.I. (2005) Diagnosis of Appendicitis with Left Lower Quadrant Pain. Journal of the Chinese Medical Association, 68, 599-603.
https://doi.org/10.1016/S1726-4901(09)70101-7
[3]
Franklin Jr., M.E., Almeida, J.A., Pérez, E.R., Michaelson, R.L.P. and Majarrez, A. (2001) Cholecystectomy and Appendectomy by Laparoscopy in a Patient with Situs Inversus Totalis: A Case Report and Review of the Literature. Asociación Mexicana de Cirugía Endoscópica, 2, 150-153.
[4]
Lee, M.R., Kim, J.H., Hwang, Y. and Kim, Y.K. (2006) A Left-Sided Periappendiceal Abscess in an Adult with Intestinal Malrotation. World Journal of Gastroenterology, 12, 5399-5400. http://dx.doi.org/10.3748/wjg.v12.i33.5399
[5]
Van Steensel, C.J. and Wereldsma, J.C. (1985) Acute Appendicitis in Complete Situs Inversus. Netherlands Journal of Surgery, 37, 117-118.
[6]
Bedoui, R., Ali Ouaer, M., Nouira, R. and Dziri, C. (2009) Acute Left-Sided Appendicitis. Tunisian Medical, 87, 873-874.
[7]
Song, J.Y., Rana, N. and Rotman, C.A. (2004) Laparoscopic Appendectomy in a Female Patient with Situs Inversus: Case Report and Literature Review. Journal of the Society of Laparoendoscopic Surgeons, 8, 175-177.
[8]
Nicholas, J.M. and Rozycki, G.S. (2001) Special Feature: Image of the Month. Diagnosis: Acute Left-Sided Appendicitis. Archives of Surgery, 136, 705-706.
[9]
Israelit, S., Brook, O.R., Nira, B.R., Guralnik, L. and Hershko, D. (2009) Left-Sided Perforated Acute Appendicitis in an Adult with Midgut Malrotation: The Role of Computed Tomography. Emergency Radiology, 16, 217-218.
https://doi.org/10.1007/s10140-008-0746-x
[10]
Welte, F.J. and Grosso, M. (2007) Left-Sided Appendicitis in a Patient with Congenital Gastrointestinal Malrotation: A Case Report. Journal of Medical Case Reports, 1, Article No. 92. https://doi.org/10.1186/1752-1947-1-92
[11]
Ahmed, J.U., Hossain, G.M.Z., Karim, M.M., Hossain, A.S.M.I., Ahmed, M. and Bhuya, M.S.A. (2007) Left Sided Acute Appendicitis with Situs Inversus in an Elderly—An Unusual Case. Journal of Chittagong Medical College Teachers’ Association, 18, 29-31. https://doi.org/10.3329/jcmcta.v18i1.3818
[12]
Golash, V. (2006) Laparoscopic Management of Acute Appendicitis in Situs Inversus. Journal of Minimal Access Surgery, 2, 220-221.
[13]
Perera, W.R. and Hennessy, O.F. (2010) An Unusual Case of Appendicitis. The American Journal of Surgery, 199, e79-e81.
https://doi.org/10.1016/j.amjsurg.2009.08.047
[14]
Huang, S.M., Yao, C.C., Tsai, T.P. and Hsu, G.W. (2008) Acute Appendicitis in Situs Inversus Totalis. Journal of the American College of Surgeons, 207, 954.
https://doi.org/10.1016/j.jamcollsurg.2008.03.030
[15]
Schwartz, J.H. and Manco, L.G. (2008) Left-Sided Appendicitis. Journal of the American College of Surgeons, 206, 590.
https://doi.org/10.1016/j.jamcollsurg.2007.05.019
[16]
Seifmanesh, H., Jamshidi, K., Kordjamshidi, A., Delpisheh, A., Peyman, H. and Yasemi, M. (2010) Acute Left-Sided Appendicitis with Situs Inversus Totalis: A Case Report. American Journal of Emergency Medicine, 28, 1058.E5-1058.E7.
https://doi.org/10.1016/j.ajem.2010.01.020
[17]
Pillow, M.T. and Valle, C. (2010) Appendicitis in an Uncommon Location. The Western Journal of Emergency Medicine, 11, 115.
[18]
Cissé, M., Touré, A.O., Konaté, I., Dieng, M., Ka, O., Touré, F.B., Dia, A. and Touré, C.T. (2010) Appendicular Peritonitis in Situs Inversus Totalis: A Case Report. Journal of Medical Case Reports, 4, Article No. 134.
https://doi.org/10.1186/1752-1947-4-134
[19]
Petrou, A., Papalambros, A., Katsoulas, N., Bramis, K., Evangelou, K. and Felekouras, E. (2010) Primary Appendiceal Mucinous Adenocarcinoma Alongside with Situs Inversus Totalis: A Unique Clinical Case. World Journal of Surgical Oncology, 8, Article No. 49. https://doi.org/10.1186/1477-7819-8-49
[20]
Abboud, B. and Daher, R. (2009) An Exceptional Cause of Left Lower Quadrant Abdominal Pain. World Journal of Gastroenterology, 15, 3451.
http://dx.doi.org/10.3748/wjg.15.3451
[21]
Hassan, A.A., El Sabagh, A. and Helmy, A.H. (2008) Laparoscopic Management of Acute Appendicitis in Situs Inversus Totalis. The Egyptian Journal of Surgery, 27, 213-215.
[22]
Pinto, A., Di Raimondo, D., Tuttolomondo, A., Fernandez, P., Caronia, A., Lagalla, R., Arnao, V., Law, R.L. and Licata, G. (2007) An Atypical Clinical Presentation of Acute Appendicitis in a Young Man with Midgut Malrotation. Radiography, 13, 164-168. https://doi.org/10.1016/j.radi.2005.10.010
[23]
Lin, C.J., Tiu, C.M., Chou, Y.H., Chen, J.D., Liang, W.Y., Chang, C.Y. (2004) CT Presentation of Ruptured Appendicitis in an Adult with Incomplete Intestinal Malrotation. Emergency Radiology, 10, 210-212.
https://doi.org/10.1007/s10140-003-0316-1
[24]
Tsumura, H., Ichikawa, T., Kagawa, T. and Nishihara, M. (2003) Successful Laparoscopic Ladd’s Procedure and Appendectomy for Intestinal Malrotation with Appendicitis. Surgical Endoscopy and Other Interventional Techniques, 17, 657-658.
https://doi.org/10.1007/s00464-002-4516-7
[25]
Keith, J.C., Thoma, J.J., Bugay, S.J., Price, P.D. and Smear, J. (2003) Asymptomatic Midgut Rotational Anomalies in Adults: 2 Case Reports and Review of the Literature. Contemporary Surgery, 59, 322-325.
[26]
Sato, H., Fujisaki, M., Takahashi, T., Maruta, M., Maeda, K. and Kuroda, M. (2001) Mucinous Cystadenocarcinoma in the Appendix in a Patient with Nonrotation: Report of a Case. Surgery Today, 31, 1012-1015.
https://doi.org/10.1007/s005950170014
[27]
Zissin, R., Kots, E., Shpindel, T. and Shapiro-Feinberg, M. (2000) Acute Appendicitis with Intestinal Non-Rotation Presenting with Partial Small Bowel Obstruction Diagnosed on CT. The British Journal of Radiology, 73, 557-559.
https://doi.org/10.1259/bjr.73.869.10884757
[28]
Carmichael, K. and Gayle, W. (1979) Situs Inversus and Appendicitis. Southern Medical Journal, 72, 1147-1149. https://doi.org/10.1097/00007611-197909000-00020
[29]
Shapiro, N.M., Michels, L.M. and Hurwitz, S. (1963) Appendicitis with Typical Symptoms but Ectopic Appendix Due to Malrotation of Colon. California Medicine, 98, 158-159.
[30]
Price, E.A. and Kane, G. (1955) Non-Rotation of Gut; with Report of Case of Left-Sided Appendiceal Abscess. South African Medical Journal, 29, 655-658.
[31]
Thomas, D.W. (1952) Left-Sided Appendicitis. British Medical Journal, 2, 43.
https://doi.org/10.1136/bmj.2.4774.43-a
[32]
Hershman, M. (1952) Left-Sided Appendicitis. British Medical Journal, 1, 1357.
https://doi.org/10.1136/bmj.1.4772.1357-a
[33]
Roche, D.A. (1952) Left-Sided Appendicitis. British Medical Journal, 2, 43.
https://doi.org/10.1136/bmj.2.4774.43-d
[34]
Rowling, J.T. (1952) Left-Sided Appendicitis. British Medical Journal, 2, 43.
https://doi.org/10.1136/bmj.2.4774.43-f
[35]
Strother-Stewart, C.R. and McVey, F. (1952) Points from Letters: Left-Sided Appendicitis. British Medical Journal, 2, 165. https://doi.org/10.1136/bmj.2.4776.165
[36]
Cannon, D.J. (1952) Points from Letters: Left-Sided Appendicitis. British Medical Journal, 2, 165. https://doi.org/10.1136/bmj.2.4776.165-b
[37]
Haddon, J.W.L. (1945) A Case of Left-Sided Appendicitis. British Medical Journal, 2, 569. https://doi.org/10.1136/bmj.2.4425.569
Craig, H.L. and Millar, D.M. (1962) Acute Appendicitis in Situs Inversus. British Medical Journal, 1, 563. https://doi.org/10.1136/bmj.1.5277.563
[40]
Marks, C. and Pokroy, M. (1955) Situs Inversus Totalis; A Report of a Case Presenting with an Acute Abdomen. South African Medical Journal, 29, 526-527.
[41]
Djohan, R.S., Rodriguez, H.E., Wiesman, I.M., Unti, J.A. and Podbielski, F.J. (2000) Laparoscopic Cholecystectomy and Appendectomy in Situs Inversus Totalis. Journal of the Society of Laparoscopic & Robotic Surgeons, 4, 251-254.
[42]
Uludag, M., Citgez, B. and Ozkurt, H. (2009) Delayed Small Bowel Perforation Due to Blunt Abdominal Trauma and Periappendicitis in a Patient with Situs Inversus Totalis: A Report of a Case. Acta Chirurgica Belgica, 109, 234-237.
https://doi.org/10.1080/00015458.2009.11680412
[43]
Ucar, A.E., Ergul, E., Aydin, R., Ozgun, Y.M. and Korukluoglu, B. (2007) Left-Sided Acute Appendicitis with Situs Inversus Totalis. The Internet Journal of Surgery, 12, 5.
[44]
Kamiyama, T., Fujiyoshi, F., Hamada, H., Nakajo, M., Harada, O. and Haraguchi, Y. (2005) Left-Sided Acute Appendicitis with Intestinal Malrotation. Radiation Medicine, 23, 125-127.
[45]
Hollander, S.C. and Springer, S.A. (2003) The Diagnosis of Acute Left-Sided Appendicitis with Computed Tomography. Pediatric Radiology, 33, 70-71.
https://doi.org/10.1007/s00247-002-0829-x
[46]
Du Toit, D.F. and Greeff, M. (1986) Acute Abdomen in a Patient with Situs Inversus. A Case Report. The South African Medical Journal, 69, 201-202.
[47]
Winter, B. and Dyk, M. (1953) Left-Sided Acute Appendicitis. Canadian Medical Association Journal, 68, 278-279.
[48]
Block, F.B. and Michael, M.A. (1938) Acute Appendicitis in Complete Transposition of Viscera: Report of Case with Symptoms Referable to Right Side Mechanism of Pain in Visceral Disease. Annals of Surgery, 107, 511-516.
https://doi.org/10.1097/00000658-193804000-00005
[49]
Willis, B.C. (1925) Appendicitis and Transposition of the Viscera. Annals of Surgery, 82, 256-259. https://doi.org/10.1097/00000658-192508000-00011
[50]
Blegen, H.M. (1949) Surgery in Situs Inversus. Annals of Surgery, 129, 244-259.
https://doi.org/10.1097/00000658-194902000-00009
[51]
Nelson, M.J. and Pesola, G.R. (2001) Left Lower Quadrant Pain of Unusual Cause. Journal of Emergency Medicine, 20, 241-245.
https://doi.org/10.1016/S0736-4679(00)00316-4
[52]
Ratani, R.S., Haller, J.O., Wang, W.Y. and Yang, D.C. (2002) Role of CT in Left-Sided Acute Appendicitis: Case Report. Abdominal Imaging, 27, 18-19.
https://doi.org/10.1007/s00261-001-0039-2
[53]
Bider, K., Kaim, A., Wiesner, W. and Bongartz, G. (2001) Acute Appendicitis in a Young Adult with Midgut Malrotation: A Case Report. European Radiology, 11, 1171-1174. https://doi.org/10.1007/s003300000734
[54]
Garg, P., Singh, M. and Marya, S.K. (1991) Intestinal Malrotation in Adults. Indian Journal of Gastroenterology, 10, 103-104.
[55]
Rodriguez, O., Avilés, A., Aquino, E., Pérez Arzola, M., Cortés, F. and Monasterio, J. (2006) Acute Abdominal Symptoms as the First Presentation of a Patient with Mirror-IMAGE dextrocardia with Situs Inverus. Boletin de la Asociacion Medica de Puerto Rico, 98, 244-248.
[56]
Bielecki, K., Gregorczyk, M. and Baczuk, L. (2006) Visceral Situs Inversus in Three Patients. Wiadomosci Lekarskie, 59, 707-709.
[57]
Tiwari, A., MacMull, S., Fox, S. and Jacob, S.A. (2006) Left Sided Abdominal Pain in a Patient with Situs Inversus. Clinical Anatomy, 19, 154-155.
https://doi.org/10.1002/ca.20201
[58]
Contini, S., Dalla Valle, R. and Zinicola, R. (1998) Suspected Appendicitis in Situs Inversus Totalis: An Indication for a Laparoscopic Approach. Surg. Laparosc. Endosc., 8, 393-394.
[59]
Prasad, V. (1992) Left Sided Appendicitis and Situs Inversus. Indian Journal of Gastroenterology, 11, 44-45.
[60]
Pillay, S.P. (1976) Perforated Appendix in Situs Inversus Viscerum. A Case Report. South African Medical Journal, 50, 141-143.
[61]
Holgersen, L.O., Kuehner, C.R. and Stanley-Brown, E.G. (1970) Acute Appendicitis in a Child with Complete Situs Inversus. Journal of Pediatric Surgery, 5, 379-380.
https://doi.org/10.1016/0022-3468(70)90198-3
[62]
Abel W.G. (1949) Acute Appendicitis with Concomitant Situs Inversus—Report of a Case. The New England Journal of Medicine, 241, 97-98.
https://doi.org/10.1056/NEJM194907212410304
[63]
Çelik, F., Güleç, S. and Gökçora, I.H. (1986) A Case of Acute Appendicitis with Situs Inversus Totalis Simulating Ureteral Colic. Turkish Journal of Medical Sciences, 4, 147-148.
[64]
Chang, K.S. (2009) 1235: Acute Appendicitis in Situs Inversus. Ultrasound in Medicine & Biology, 35, S163. https://doi.org/10.1016/j.ultrasmedbio.2009.06.619
[65]
Palanivelu, C., Rangarajan, M., John, S.J., Senthilkumar, R. and Madhankumar, M.V. (2007) Laparoscopic Appendectomy for Appendicitis in Uncommon Situations: The Advantages of a Tailored Approach. Singapore Medical Journal, 48, 737-740.
[66]
Akbulut, S., Ulku, A., Senol, A., Tas, M. and Yagmur, Y. (2010) Left-Sided Appendicitis: Review of 95 Published Cases and a Case Report. World Journal of Gastroenterology, 16, 5598-5602. http://dx.doi.org/10.3748/wjg.v16.i44.5598
