Appendicular Peritonitis in Situs Inversus Totalis: A Case Report

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Abstract and Introduction

Abstract

Introduction: Situs inversus is a congenital anomaly characterized by the transposition of the abdominal viscera. When associated with dextrocardia, it is known as situs inversus totalis. This condition is rare and can be a diagnostic problem when associated with appendicular peritonitis.
Case presentation: We report the case of a 20-year-old African man who presented to the emergency department with a 4-day history of diffuse abdominal pain, which began in his left iliac region and hypogastrium. After examination, we initiated a surgical exploration for peritonitis. We discovered a situs inversus at the left side of his liver, and his appendix was perforated in its middle third. A complementary post-operative thoracic and abdominal tomodensitometry revealed a situs inversus totalis.
Conclusion: Appendicular peritonitis in situs inversus is a rare association that can present a diagnostic problem. Morphologic exploration methods such as ultrasonography, tomodensitometry, magnetic resonance imaging, and laparoscopy may contribute to the early management of the disease and give guidance in choosing the most appropriate treatment for patients.

Introduction

Situs inversus is a congenital anomaly characterized by the transposition of the abdominal viscera. It may or may not be associated with dextrocardia, also known as situs inversus totalis.^[1,2] Generally, this rare genetic anomaly is discovered incidentally, often when a radiographic assessment of a patient is undertaken, particularly to investigate an abdominal infection. We report a case of situs inversus discovered in relation to the treatment of generalized acute peritonitis of appendicular origin. This case is particularly interesting because of the scarcity of this association and the diagnostic difficulties that may arise because of unusual symptoms.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cite this: Appendicular Peritonitis in Situs Inversus Totalis: A Case Report - Medscape - May 01, 2010.

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