Laparoscopic management of acute appendicitis in situs inversus

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Abstract

Situs inversus is often detected incidentally in adults during imaging for a acute surgical emergency. We present a case of acute appendicitis in an adult who was previously unaware about his situs anomaly. A laparoscopic approach is helpful to deal with this condition. A 40 year old man was admitted with history of acute left lower abdominal pain, with uncontrolled diabetic keto-acidosis. Clinically, he was diagnosed as acute diverticulitis with localized peritonitis. Subsequent imaging studies and laparoscopy confirmed the diagnosis of situs inversus and acute left- sided appendicitis.

He successfully underwent laparoscopic appendectomy. His postoperative recovery was uneventful. Although technically more challenging because of the reverse laparoscopic view of the anatomy, the laparoscopic diagnosis and management of acute appendicitis is indicated in situs inversus.

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Abdominal manifestations of situs anomalies in adults.

Ann Fulcher, Mary Turner (2015)

A study was made of 19 adults with situs anomalies (situs inversus [n = 10], situs ambiguous with polysplenia [n = 8], situs ambiguous with asplenia [n = 1]). No patient had congenital heart disease, bowel obstruction related to malrotation, or immune deficiency disorders. All 10 patients with situs inversus had mirror-image location of the abdominal organs relative to situs solitus; nine had dextrocardia, and one had levocardia. The eight adults with situs ambiguous with polysplenia demonstrated a spectrum of abnormalities. All had some degree of abdominal heterotaxy, including midline livers and gallbladders (n = 5), right-sided stomachs and spleens (n = 3), and rotational abnormalities of the small bowel and colon (n = 7). Other findings included multiple spleens (n = 7), interruption of the inferior vena cava (IVC) with azygous or hemiazygous continuation (n = 7), truncation of the pancreas (n = 6), and ipsilateral location of the aorta and IVC (n = 1). In the one patient with asplenia, a midline liver, right-sided stomach, bowel rotation abnormality, IVC interruption, and pancreatic truncation were noted. Recognition of the spectrum of situs anomalies is important because the altered anatomy associated with these anomalies may result in confusing imaging findings when seen in conjunction with acquired diseases. Copyright RSNA, 2002

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Early laparoscopy as a routine procedure in the management of acute abdominal pain: a review of 1,320 patients.

V Golash, P Willson (2005)

Acute abdominal pain is a common cause for presentation to the emergency room and hospital admission. Many of these patients will undergo exploration for suspected appendicitis, but in 20-35% of cases a normal appendix is found. Because of the limited access provided by the gridiron incision, a definitive diagnosis may not be found. Other patients may be treated conservatively and discharged, only to return with recurrent pain or more definitive symptoms of pathology. In patients with acute abdominal pain, early laparoscopy is an accurate means of both making a definitive diagnosis and avoiding a delay in the diagnosis. We performed a retrospective analysis of 1,320 consecutive patients with acute abdominal pain over a 62-month period. All patients underwent diagnostic laparoscopy within 48 h of admission. We evaluated the initial clinical diagnosis, the laparoscopic diagnosis, and the subsequent outcome in this group of patients. Individuals with abdominal trauma were excluded from the study, and all patients were >12 years of age. A definitive diagnosis was made in 90% of patients after diagnostic laparoscopy. Laparoscopy changed the clinical diagnosis in 30% of cases. (83%) of patients underwent a laparoscopic operation for management of their condition at the time of diagnosis. In 92 patients (7%), conversion to laparotomy was required to manage their condition. Peritonitis was present in 180 patients; of 110 of them had appendicitis. Twelve patients developed complications related to the diagnostic laparoscopy or the laparoscopic operation, and there was one postoperative death due to a perforated gastric malignancy. Mean operating time was 30 min (range, 17-90). Early diagnostic laparoscopy and treatment results in the accurate, prompt, and efficient management of acute abdominal pain. This technique reduces the rate of unnecessary laparotomy and right iliac fossa gridiron incisions and increases the diagnostic accuracy in these patients. This treatment method is feasible where facilities are available to accommodate the workload and there are practitioners with the requisite expertise.

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Suspected appendicitis in situs inversus totalis: an indication for a laparoscopic approach.

R. Valle, S Contini, R Zinicola (1998)

We report a case of acute appendicitis in situs inversus treated by laparoscopy. In our opinion, diagnostic laparoscopy is indicated if acute appendicitis is suspected in a patient with situs inversus totalis, either because the pain can be referred to the right iliac fossa in about 50% of the patients, or because the incision in open surgery cannot be sufficient to allow complete exploration of the abdomen. The operation can then be carried out laparoscopically if possible; if not, an appropriate surgical incision can be made.

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Author and article information

Journal

Journal ID (nlm-ta): J Minim Access Surg

Journal ID (publisher-id): JMAS

Title: Journal of Minimal Access Surgery

Publisher: Medknow Publications (India )

ISSN (Print): 0972-9941

ISSN (Electronic): 1998-3921

Publication date (Print): December 2006

Volume: 2

Issue: 4

Pages: 220-221

Affiliations

Department of Surgery, Sultan Qaboos Hospital, Salalah - 211, Sultanate of Oman

Author notes

Address for correspondence: Vishwanath Golash, Department of Surgery, Sultan Qaboos hospital, P.O. Box; 98, Salalah - 211, Sultanate of Oman. E-mail: golash@ 123456omantel.net.om

Article

Publisher ID: JMAS-2-220

DOI: 10.4103/0972-9941.28184

PMC ID: 3016484

PubMed ID: 21234150

SO-VID: 6a95e104-1b32-4092-945c-51f91fac980b

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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Laparoscopic management of acute appendicitis in situs inversus

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Most cited references 5

Abdominal manifestations of situs anomalies in adults.

Early laparoscopy as a routine procedure in the management of acute abdominal pain: a review of 1,320 patients.

Suspected appendicitis in situs inversus totalis: an indication for a laparoscopic approach.

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