Abstract
Situs inversus may mimic the pain localization of acute abdomen. In patients with acute abdomen, especially elderly patients who are medically healthy, physicians should cautiously diagnose the etiology of acute abdomen in combination with imaging studies.
Keywords: appendicitis, diagnosis, image, situs inversus totalis
Situs inversus may mimic the pain localization of acute abdomen. In patients with acute abdomen, especially elderly patients who are medically healthy, physicians should cautiously diagnose the etiology of acute abdomen in combination with imaging studies.
1. CASE PRESENTATION
An 87‐year‐old woman medically healthy presented with abdominal pain. Although she was diagnosed with dextrocardia in her young age, she did not declare it on admission. Abdominal tenderness localized to the left lower quadrant, which corresponded to McBurney's point was revealed, however, on the left side. Laboratory tests showed leukocytosis (8700/µL) and elevated C‐reactive protein (17.4 mg/dL). Computed tomography scanning revealed transposition of all viscera and left‐sided swollen appendix with fecolith and mesenteric panniculitis (Figure 1). She underwent laparoscopic appendectomy under the diagnosis of acute appendicitis and was discharged from the hospital 10 days later.
FIGURE 1.
Axial and coronal images of abdominal computed tomography. In addition to the transposition of all viscera, left‐sided swollen appendix with fecolith and mesenteric panniculitis (arrow) is observed, which is consistent with appendicitis
Unusual pain localization in situs inversus mimic the diagnosis of acute abdomen. 1 That is because patients of situs inversus totalis may not be aware of it themselves, or if they know, may forget to declare it due to good prognosis in cases without heart defects or other underlying diagnoses. Moreover, appendicitis with situs inversus does not always simply demonstrate opposite left lower abdominal pain owing to the nervous system occasionally not displaying the corresponding transposition although the viscera are transported. 2 About 18.4%‐31% of patients with situs inversus totalis and midgut malrotation reported to demonstrate right lower abdominal pain due to left‐sided appendicitis. 2 In patients with acute abdomen, especially in elderly patients who are medically healthy, physicians should cautiously diagnose in combination with the imaging studies.
CONFLICTS OF INTEREST
The authors declare no conflicts of interest in association with this study.
AUTHORS’ CONTRIBUTION
YO: contributed to the clinical management of the patients, wrote the first draft, and managed all the submission process. RH, SU, AY, and YN: contributed to the clinical management of the patient and revised the manuscript. FO: revised the manuscript.
Otsuka Y, Hayashi R, Urano S, Yashima A, Nanba Y, Otsuka F. Left‐sided appendicitis due to situs inversus totalis. Clin Case Rep. 2021;9:1791–1792. 10.1002/ccr3.3734
DATA AVAILABILITY STATEMENT
The data regarding this case report are only available from the corresponding author upon reasonable request by considering the protection of patient's privacy.
REFERENCES
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data regarding this case report are only available from the corresponding author upon reasonable request by considering the protection of patient's privacy.