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.