[Acute appendicitis in situs inversus totalis].

Situs inversus totalis is a relatively rare congenital anatomic anomaly in which there is complete right to left reversal (transposition) of the thoracic and abdominal organs The incidence of acute appendicitis with situs inversus totalis is between 0.016% and 0.024%. We present two cases of situs inversus totalis with acute appendicitis. Appendicectomy was performed on both patients as an emergency procedure. Postoperative recovery was uneventful in both of the patients and were free of their symptoms in their follow up period. Acute appendicitis in situs inversus is a rare association that can present a diagnostic problem. Morphologic exploration methods such as ultrasonography, computed tomography, 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. . Acute Appendicitis In Situs Inversus Totalis Report of two cases : 1 2 Deepak G. Udapudi , Raghuveer Karne 1 2 Professor, Post Graduate J.J.M. Medical College, Davangere, Karnataka [Received : 22/02/2014, Revised : 20/03/2014, Accepted : 23/04/2014] 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 1,2 inversus totalis 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 two cases of situs inversus discovered while evaluating acute pain in left iliac fossa and diagnosed to be acute appendicitis. This is particularly interesting because of the scarcity of this association and the diagnostic difficulties that may arise because of unusual site of pain. Case Reports CASE 1 : A 22 year-old female patient presented to our hospital with 2-days history of acute abdominal pain in the left iliac region. This pain was associated with fever. She had a fever of 100°F, a pulse rate of 100/minute and blood pressure of 120/70 mm Hg. Her physical examination revealed abdominal tenderness predominantly over left iliac fossa. Sonography of abdomen and lower chest revealed a situs inversus totalis with dextrocardia with acute appendicitis. An X-ray chest confirmed dextrocardia. CT abdomen confirmed findings of situs inversus totalis with acute appendicitis. Laboratory investigations showed a white blood cell 3 count of 13,900/mm with 93% neutrophils, 42% 3 hematocrit, and platelets at 323,000/mm . J Pub Health Med Res 2014;2(1):41-43 CASE REPORT Address Correspondence to : Dr. Deepak G. Udapudi Professor of Surgery, JJMMC, Davangere. Mob. : 8904406592 E-mail : [email protected] Patient was taken up for an emergency surgery. Exploration showed inflamed oedematous left sided appendix. Appendectomy was performed. Histopathology confirmed acute appendicitis. No postoperative complication was noted and she was discharged home five days after her operation. CASE 2 : A 17 year old male patient presented to our hospital with one day history of acute abdominal pain in the left iliac region. This pain was associated with nausea and vomiting. He was afebrile, had a pulse rate of 90/minute and blood pressure of 100/70 mm Hg. His physical examination revealed abdominal tenderness predominantly over left iliac fossa. Figure 1-Peroperative view of left sided caecum and appendix.