Left-sided appendicitis revealing situs inversus: diagnostic challenges and emergency surgical management strategies – a case report

Abstract

Situs inversus is a rare congenital anomaly that results in the transposition of the abdominal organs, leading to atypical clinical presentations, such as left-sided appendicitis. Acute appendicitis is the most common cause of right iliac fossa pain; however, its occurrence on the left side is exceedingly rare and often leads to diagnostic delays, which may result in serious complications such as peritonitis if not promptly addressed. Imaging modalities, particularly computed tomography (CT), play a critical role in the anatomical and pathological diagnosis, thereby guiding appropriate surgical management. We present the case of a 67-year-old patient with a history of ileocecal tuberculosis, myocardial infarction, and ischemic stroke, who was admitted with left iliac fossa pain, initially suspected to be due to sigmoiditis. A CT scan revealed situs inversus with high-positioned left-sided appendicitis, prompting the indication for urgent laparoscopy. Surgical exploration confirmed a retrocecal appendicitis with minimal peritoneal effusion, and an appendectomy was performed.