Department of Surgery, Diyarbakir Education and Research Hospital, 21400, Diyarbakir, Turkey.
J Gastrointest Surg. 2010 Sep;14(9):1422-8. doi: 10.1007/s11605-010-1210-2. Epub 2010 Jun 22.
Situs inversus (SI) and midgut malrotation (MM) are uncommon anatomic anomalies that complicate diagnosis and management of acute abdominal pain.
We present two cases of left-sided acute appendicitis with situs inversus totalis and a literature review of studies published in English language on left-sided acute appendicitis, accessed via Pubmed and Google Scholar database.
Sixty-three published cases of left-sided acute appendicitis were evaluated, and two patients (M:16 yr, F:17 yr) who presented to our clinic with left lower quadrant pain caused by left-sided acute appendicitis were reported. Thirty-five of the patients were male and 30 were female (including our patients) with age range from 8 to 63 years and median age of 26.7 +/- 14.0 years. Fifty-three patients had situs inversus totalis (SIT), 8 had MM and two were with malrotation of the caecum. Thirty-eight patients had applied to the hospital with left lower quadrant pain, 12 with right and 6 with bilateral lower quadrant pain. Thirty patients were diagnosed as having SIT or MM, while the diagnosis in 12 patients was established during the intraoperative period. Eleven patients with SIT were aware of having this anomaly. Five of the patients underwent laparoscopic appendectomy and in two patients laparoscopic appendectomy and cholecystectomy were performed in one session. Preoperative diagnosis has been easier to achieve after 1985, when ultrasonography (USG) and computed tomography (CT) were introduced into the medical practice.
SIT and MM should be taken into consideration in patients with findings of the physical examination suspicious for left-sided acute appendicitis. X-ray, USG, CT and diagnostic laparoscopy are beneficial in developing the differential diagnosis.
内脏转位（SI）和中肠旋转不良（MM）是罕见的解剖异常，会使急性腹痛的诊断和治疗变得复杂。
我们报告了两例完全性内脏转位伴左侧急性阑尾炎的病例，并对 Pubmed 和 Google Scholar 数据库中以英文发表的关于左侧急性阑尾炎的研究进行了文献回顾。
共评估了 63 例已发表的左侧急性阑尾炎病例，报告了 2 例以左侧下腹痛就诊于我院的患者（男，16 岁；女，17 岁），病因均为左侧急性阑尾炎。35 例患者为男性，30 例为女性（包括我们的患者），年龄 8 至 63 岁，中位数年龄为 26.7 +/- 14.0 岁。53 例患者存在完全性内脏转位（SIT），8 例存在 MM，2 例存在盲肠旋转不良。38 例患者以左侧下腹痛就诊，12 例以右侧腹痛就诊，6 例以双侧下腹痛就诊。30 例患者被诊断为 SIT 或 MM，而 12 例患者的诊断是在手术期间确定的。11 例 SIT 患者已知存在这种异常。5 例患者接受了腹腔镜阑尾切除术，2 例患者在一次手术中同时进行了腹腔镜阑尾切除术和胆囊切除术。1985 年超声（USG）和计算机断层扫描（CT）引入医学实践后，术前诊断变得更容易。
对于体格检查怀疑左侧急性阑尾炎的患者，应考虑到 SIT 和 MM。X 射线、USG、CT 和诊断性腹腔镜检查有助于开展鉴别诊断。
