Department of Surgery, Faculty of Medicine, Lucian Blaga University of Sibiu, Romania;
Rom J Morphol Embryol. 2021 Jul-Sep;62(3):861-867. doi: 10.47162/RJME.62.3.27.
The revelation of situs inversus totalis by a peritoneal syndrome is an extremely rare event. The association of this condition with sigmoid diverticulitis and agenesis of the vermiform appendix has not been described in the literature. This paper aims to present the first case of this type while screening the literature on this topic. The authors present the case of a sigmoid diverticulitis associated with situs inversus totalis and agenesis of the vermiform appendix, in a 44-year-old male patient. Because of abdominal pain located in the right iliac fossa, elevated temperature (38.2°C) and biological examinations, acute appendicitis was rather simulated and considered as a presumptive diagnosis. Diagnostic accuracy was achieved during laparoscopic exploration of the peritoneal cavity, which proved the coexistence of visceral transposition, appendiceal agenesis and sigmoid diverticulitis, usually noted as a rare finding. Secondly, we performed a systematic search on PubMed® and Google Scholar® databases introducing the following terms: situs inversus totalis, acute appendicitis. Given the time span of the last 30 years, we have obtained a small number of cases in which symptoms that are specific to acute appendicitis have been found in patients with situs inversus totalis. Due to the rare number of cases, it is difficult to establish a preoperative diagnosis. Usually, this diagnosis is revealed as an intraoperative surprise. A careful clinical examination and a set of standardized paraclinical examinations can guide the diagnosis. The patient's evolution was favorable, without any other changes at the subsequent examinations.
全内脏反位合并乙状结肠憩室炎和阑尾缺如被腹膜综合征揭示是一种极其罕见的事件。这种情况与乙状结肠憩室炎和阑尾缺如的关联在文献中尚未描述。本文旨在介绍首例此类病例，并对该主题的文献进行筛选。作者介绍了一例全内脏反位合并乙状结肠憩室炎和阑尾缺如的病例，患者为 44 岁男性。由于右髂窝处腹痛、发热（38.2°C）和生物检查，急性阑尾炎被模拟并被认为是疑似诊断。在腹腔镜探查腹膜腔期间获得了诊断准确性，证明了内脏易位、阑尾缺如和乙状结肠憩室炎的共存，这通常被认为是一种罕见的发现。其次，我们在 PubMed®和 Google Scholar®数据库中进行了系统搜索，输入了以下术语：全内脏反位，急性阑尾炎。鉴于过去 30 年的时间跨度，我们发现了少数病例，这些病例在全内脏反位患者中出现了特定于急性阑尾炎的症状。由于病例数量稀少，术前诊断困难。通常，这种诊断在术中令人惊讶地揭示。仔细的临床检查和一组标准化的辅助检查可以指导诊断。患者的病情好转，后续检查无其他变化。
