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      Laparoscopic appendectomy in an adult patient with situs inversus totalis

      case-report

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          Abstract

          Left-sided appendicitis is usually caused by situs inversus totalis or midgut malrotation. Clinical and imaging diagnoses have been presented relatively fully in the literature. However, this is a rare condition, and each related case should be further reported to help the day-to-day clinician better investigate and understand. Therefore, in this paper, we present a case of left-sided acute appendicitis in an adult male patient with situs inversus totalis. In addition, we also discuss the laparoscopic technique of the left-sided appendectomy as it is technically more difficult because of the mirror nature of the anatomy.

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          Left-sided appendicitis: review of 95 published cases and a case report.

          Mahmut Tas, Sami Akbulut, Ayhan Senol … (2010)
          To give an overview of the literature on left-sided acute appendicitis (LSAA) associated with situs inversus totalis (SIT) and midgut malrotation (MM). We present a new case of LSAA with SIT and a literature review of studies published in the English language on LSAA, accessed via PubMed and Google Scholar databases. Ninety-five published cases of LSAA were evaluated and a 25-year-old female, who presented to our clinic with left lower abdominal pain caused by LSAA, is reported. In the reviewed literature, fifty-seven patients were male and 38 were female with an age range of 8 to 82 years and a median age of 29.1 ± 15.9 years. Sixty-six patients had SIT, 23 had MM, three had cecal malrotation, and two had a previously unnoted congenital abnormality. Fifty-nine patients had presented to the hospital with left lower, 14 with right lower and seven with bilateral lower quadrant pain, and seven subjects complained of left upper quadrant pain. The diagnosis was established preoperatively in 49 patients, intraoperatively in 19, and during the postoperative period in five; 14 patients were aware of having this anomaly. The data of eight patients were not unavailable. Eleven patients underwent laparoscopic appendectomy, which was combined with cholecystectomy in two cases. Histopathological examination of the appendix specimens revealed adenocarcinoma in only two of 95 patients. The diagnosis of left lower quadrant pain is based on well-established clinical symptoms, physical examination and physician's experience.
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            Left-sided acute appendicitis with situs inversus totalis: review of 63 published cases and report of two cases.

            Alper Caliskan, Sami Akbulut, Abdülselam Ekin … (2010)
            Situs inversus (SI) and midgut malrotation (MM) are uncommon anatomic anomalies that complicate diagnosis and management of acute abdominal pain. We present two cases of left-sided acute appendicitis with situs inversus totalis and a literature review of studies published in English language on left-sided acute appendicitis, accessed via Pubmed and Google Scholar database. Sixty-three published cases of left-sided acute appendicitis were evaluated, and two patients (M:16 yr, F:17 yr) who presented to our clinic with left lower quadrant pain caused by left-sided acute appendicitis were reported. Thirty-five of the patients were male and 30 were female (including our patients) with age range from 8 to 63 years and median age of 26.7 +/- 14.0 years. Fifty-three patients had situs inversus totalis (SIT), 8 had MM and two were with malrotation of the caecum. Thirty-eight patients had applied to the hospital with left lower quadrant pain, 12 with right and 6 with bilateral lower quadrant pain. Thirty patients were diagnosed as having SIT or MM, while the diagnosis in 12 patients was established during the intraoperative period. Eleven patients with SIT were aware of having this anomaly. Five of the patients underwent laparoscopic appendectomy and in two patients laparoscopic appendectomy and cholecystectomy were performed in one session. Preoperative diagnosis has been easier to achieve after 1985, when ultrasonography (USG) and computed tomography (CT) were introduced into the medical practice. SIT and MM should be taken into consideration in patients with findings of the physical examination suspicious for left-sided acute appendicitis. X-ray, USG, CT and diagnostic laparoscopy are beneficial in developing the differential diagnosis.
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              Laparoscopic management of acute appendicitis in situs inversus

              Vishwanath Golash (2006)
              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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                Author and article information

                Contributors
                Trung V Hoang:
                ORCID: https://orcid.org/0000-0001-7857-4387
                Huan T Hoang:
                ORCID: https://orcid.org/0000-0002-3487-174X
                Hoai T Vo
                Vichit Chansomphou:
                ORCID: https://orcid.org/0000-0002-3614-1054
                Journal
                Journal ID (nlm-ta): J Surg Case Rep
                Journal ID (iso-abbrev): J Surg Case Rep
                Journal ID (publisher-id): jscr
                Title: Journal of Surgical Case Reports
                Publisher: Oxford University Press
                ISSN (Electronic): 2042-8812
                Publication date Collection: March 2023
                Publication date (Electronic): 14 March 2023
                Publication date PMC-release: 14 March 2023
                Volume: 2023
                Issue: 3
                Electronic Location Identifier: rjad134
                Affiliations
                Department of Radiology, Thien Hanh Hospital , Buon Ma Thuot, Vietnam
                Department of Radiology, Thien Hanh Hospital , Buon Ma Thuot, Vietnam
                Department of Radiology, Tam Tri Nha Trang General Hospital , Nha Trang, Vietnam
                Department of Radiology, Savannakhet Medical-Diagnostic Center, Kaysone Phomvihane , Laos
                Author notes
                Correspondence address. Department of Radiology, Thien Hanh Hospital, 17 Nguyen Chi Thanh Street, Buon Ma Thuot 630000, Vietnam. Tel: +84-34-957-4560; E-mail: dr.hoangvantrungradiology@ 123456gmail.com
                Author information
                https://orcid.org/0000-0001-7857-4387
                https://orcid.org/0000-0002-3487-174X
                https://orcid.org/0000-0002-3614-1054
                Article
                Publisher ID: rjad134
                DOI: 10.1093/jscr/rjad134
                PMC ID: 10014166
                PubMed ID: 36926629
                SO-VID: 9f5314f9-5641-4135-8a07-004a0a08e961
                Copyright © Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2023.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 15 January 2023
                Date accepted : 20 February 2023
                Page count
                Pages: 3
                Categories
                Subject: Case Report
                Subject: AcademicSubjects/MED00910
                Subject: jscrep/0160

                Keywords: laparoscopic appendectomy,left-sided appendicitis,situs inversus totalis
                Data availability:
                Keywords: laparoscopic appendectomy, left-sided appendicitis, situs inversus totalis

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