Abstract

HERRERA-MONCADA, ISABEL CRISTINA; ZULUAGA-RESTREPO, JUAN DAVID  and  MEZA, MARIA DEL MAR. Acute appendicitis in situs inversus totalis: a case report. CES Med. [online]. 2012, vol.26, n.2, pp.209-214. ISSN 0120-8705.

ABSTRACT Introduction: Acute appendicitis is the most frequent abdominal condition that requires surgical intervention in the world. The diagnosis is based on clinical symptoms, image findings and surgeon expertise. About one third of the patients don't have the usual right lower quadrant pain, explained for the different positions of cecal appendix. Left acute appendicitis is rare and it happens due a very long right appendix or in patients with congenital conditions such as situs inversus totalis and midgut malrotation. The situs inversus totalis is an extremely rare condition that afects 0,001 - 0.01 % of population (1). It's a difficult diagnosis, and usually is incidental, when the pacient is studied with the routine exams. These patients have a 0,016 - 0,024% incidence of developing acute apendicitis, and generally present some complication. The diagnosis of surgical pathologies in patients with anatomical variations is still a challenge, and this is the reason to keep present these diseases. Methods: in this opportunity we present a case of left acute appendicitis in a patient with situs inversus totalis, without preoperative knowledge about this condition and searched about this topic in the published literature through PubMed, finding few published cases, that makes more relevant the report of this one. Results: there have been published 95 cases of acute apendicitis in situs inversus totalis, 57 were men and 38 women. Almost all the patients presented left lower quadrant pain, but a few ones presented pain in both sides. Conclusiones: Left acute appendicitis is a rare condition the practitioners have to have in mind in patients with left lower quadrant pain. The images and laparoscopic interventions are useful to make an opportune diagnosis and treatment

Keywords : Situs inversus; Left acute appendicitis; Appendicectomy.

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