Oh Joo Suk, Kim Ki Wook, Cho Hang Joo
Department of Emergency Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea School of Medicine, Uijeongbu, Korea.
J Korean Surg Soc. 2012 Sep;83(3):175-8. doi: 10.4174/jkss.2012.83.3.175. Epub 2012 Aug 27.
Situs inversus totalis is a rare inherent disease in which the thoracic and abdominal organs are transposed. Symptoms of appendicitis in situs inversus (SI) may appear in the left lower quadrant, and the diagnosis of appendicitis is very difficult. We report a case of left-sided appendicitis diagnosed preoperatively after dextrocardia that was detected by chest X-ray, although the chief complaint of the patient was left lower-quadrant pain. The patient underwent an emergent laparoscopic appendectomy under the diagnosis of appendicitis after abdominal computed tomography (CT). In patients with left lower quadrant pain, if the chest X-ray shows dextrocardia, one should suspect left-sided appendicitis. A strong suspicion of appendicitis and an emergency laparoscopic operation after confirmation of the diagnosis by imaging modalities including abdominal CT or sonography can reduce the likelihood of misdiagnosis and complications including perforation and abscess. Laparoscopic appendectomy in SI was technically more challenging because of the mirror nature of the anatomy.
全内脏转位是一种罕见的先天性疾病，其中胸腹部器官发生转位。内脏转位（SI）患者的阑尾炎症状可能出现在左下腹，阑尾炎的诊断非常困难。我们报告一例术前诊断为左侧阑尾炎的病例，该病例通过胸部X线检查发现有右位心，尽管患者的主要诉求是左下腹疼痛。患者在腹部计算机断层扫描（CT）后被诊断为阑尾炎，并接受了急诊腹腔镜阑尾切除术。对于左下腹疼痛的患者，如果胸部X线显示右位心，应怀疑左侧阑尾炎。高度怀疑阑尾炎并在通过包括腹部CT或超声检查等影像学手段确诊后进行急诊腹腔镜手术，可以降低误诊的可能性以及穿孔和脓肿等并发症的发生。由于解剖结构呈镜像，SI患者的腹腔镜阑尾切除术在技术上更具挑战性。
