Perforated Appendicitis in a patient with Situs Inversus totalis: a case report

ABSTRACT

Appendicitis is one of the most common disease in emergency department(ED), but produces perplexing diagnostic problems. A complete understanding of the anatomy, pathophysiology, and presenting signs and symptoms of appendicitis, combined with thorough history and physical examination, will be the most important factors in allowing emergency physician to make the correct diagnosis of appendicitis. Situs inversus totalis is a rare congenital anomaly occurring in every 10,000 to 50,000 people. Its etiology is obscure but apparently dose not influence normal health or life expectancy. We present a case of perforates appendicitis with situs inversus totalis in a 24-year-old woman whose chief complaint was pain on the left lower quadrant of the abdomen. Chest and abdominal X-ray showed situs inversus totalis, but these typical findings of situs inversus totalis were missed before performing abdominal ultrasonography in ED. We must carefully consider whether congenital anomaly is or not by physical examination and X-ray finding. For patients whose diagnosis is less clear, additional diagnostic tool, for instance ultrasonography is recommended in ED.