Acute appendicitis in a patient with situs viscerum inversus totalis: Role of laparoscopic approach. A case report and brief literature review
- Resource Type
- Authors
- Antonino Agrusa; Giuseppe Di Buono; Brenda Randisi; Elisa Maienza; Salvatore Buscemi; Giorgio Romano
- Source
- International Journal of Surgery Case Reports
- Subject
- Laparoscopic surgery
congenital, hereditary, and neonatal diseases and abnormalities
medicine.medical_specialty
Abdominal pain
Midgut malrotation
medicine.medical_treatment
Case Report
03 medical and health sciences
Standard anatomical position
0302 clinical medicine
otorhinolaryngologic diseases
medicine
Urgent laparoscopy
Acute appendicitis
Situs viscerum inversus
business.industry
General surgery
Appendix
medicine.anatomical_structure
030220 oncology & carcinogenesis
030211 gastroenterology & hepatology
Surgery
Differential diagnosis
medicine.symptom
business
- Language
- English
Highlights • Abdominal pain due to acute appendicitis in one of the most causes of access to Emergency Room requiring surgical consult and treatment. • The occurrence of anatomical anomalies should be considered especially when clinical and imaging features are misleading. In these cases laparoscopic surgery can be a safe tool in order to confirm uncertain diagnosis. • We report a case of acute appendicitis in a 23-year-old Caucasian men with situs viscerum inversus detected on radiological investigation. • Laparoscopic approach was used to confirm the diagnosis and to perform appendectomy. Trocars placement was tailored for this peculiar case. • Situs viscerum inversus and midgut malrotation should be taken into consideration in patients with findings of the physical examination suspicious for left-sided acute appendicitis.
Introduction Abdominal pain due to acute appendicitis in one of the most causes of access to Emergency Room requiring surgical consult and treatment. The occurrence of anatomical anomalies should be considered especially when clinical and imaging features are misleading. In these cases laparoscopic surgery can be a safe tool in order to confirm uncertain diagnosis. Case report We report a case of acute appendicitis in a 23-year-old Caucasian men with situs viscerum inversus detected on radiological investigation. Laparoscopic approach was used to confirm the diagnosis and to perform appendectomy. Trocars placement was tailored for this peculiar case. Discussion One third of patient with acute appendicitis complains abdominal pain in an unexpected location due to various anatomical position of appendix. Left-sided acute appendicitis is a cause of misdiagnosis and it can occur in association with anatomical anomalies such as situs viscerum inversus and midgut malrotation. Laparoscopic surgery may represent a valuable approach in terms of differential diagnosis and treatment in these patients. Conclusion Left-sided acute appendicitis should always be considered in young male patients with left lower quadrant pain. Laparoscopic approach is useful and safe procedure both for diagnosis and treatment of these unclear clinical pictures.