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 localised to the left lower quadrant, which corresponded to McBurney’s point was revealed; however, on the left side. Laboratory tests showed leukocytosis (8,700/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 ). She underwent laparoscopic appendectomy under the diagnosis of acute appendicitis and was discharged from the hospital 10 days later.
Unusual pain localization in situs inversus mimic the diagnosis of acute abdomen1. 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 transported2. In patients with acute abdomen, especially in elderly patients who are medically healthy, physicians should cautiously diagnose in combination with the imaging studies.