Di Buono Giuseppe, Maienza Elisa, Buscemi Salvatore, Randisi Brenda, Romano Giorgio, Agrusa Antonino
Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
Int J Surg Case Rep. 2020;77S(Suppl):S29-S33. doi: 10.1016/j.ijscr.2020.10.047. Epub 2020 Oct 17.
Abdominal pain due to acute appendicitis in one of the most causes of access to Emergency Room requiring surgical consult and treatment. The occurrence of anatomical anomalies should be considered especially when clinical and imaging features are misleading. In these cases laparoscopic surgery can be a safe tool in order to confirm uncertain diagnosis.
We report a case of acute appendicitis in a 23-year-old Caucasian men with situs viscerum inversus detected on radiological investigation. Laparoscopic approach was used to confirm the diagnosis and to perform appendectomy. Trocars placement was tailored for this peculiar case.
One third of patient with acute appendicitis complains abdominal pain in an unexpected location due to various anatomical position of appendix. Left-sided acute appendicitis is a cause of misdiagnosis and it can occur in association with anatomical anomalies such as situs viscerum inversus and midgut malrotation. Laparoscopic surgery may represent a valuable approach in terms of differential diagnosis and treatment in these patients.
Left-sided acute appendicitis should always be considered in young male patients with left lower quadrant pain. Laparoscopic approach is useful and safe procedure both for diagnosis and treatment of these unclear clinical pictures.
急性阑尾炎所致腹痛是患者前往急诊室就诊并需要外科会诊及治疗的最常见原因之一。尤其当临床和影像学特征具有误导性时，应考虑解剖学异常的存在。在这些情况下，腹腔镜手术可作为一种安全的手段来确诊不确定的诊断。
我们报告一例23岁白种男性急性阑尾炎病例，其在影像学检查中被发现有内脏反位。采用腹腔镜方法确诊并进行阑尾切除术。针对这一特殊病例调整了套管针的放置位置。
三分之一的急性阑尾炎患者因阑尾的各种解剖位置而在意外部位出现腹痛。左侧急性阑尾炎是误诊的原因之一，它可能与内脏反位和中肠旋转不良等解剖学异常同时发生。对于这些患者，腹腔镜手术在鉴别诊断和治疗方面可能是一种有价值的方法。
对于左下腹疼痛的年轻男性患者，应始终考虑左侧急性阑尾炎的可能。腹腔镜方法对于诊断和治疗这些不明确的临床情况是有用且安全的手术。
