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左侧阑尾炎伴内脏反位:诊断挑战与急诊手术管理策略——病例报告

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

作者信息

Mahmoudi Mohammed, Slimi Youness, Frikal Mohammed, Boukabous Houssam, Guellil Abdelali, Jabi Rachid, Bouziane Mohammed

机构信息

Department of Visceral Surgery and Digestive Oncology A, Mohammed VI University Hospital, BP 4806 Oujda Universite, 60049 Oujda, Morocco.

Faculty of Medicine and Pharmacy, Mohammed 1st University, BP 724 Hay Al Quods, 60000 Oujda, Morocco.

出版信息

J Surg Case Rep. 2025 Mar 12;2025(3):rjaf130. doi: 10.1093/jscr/rjaf130. eCollection 2025 Mar.

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.

摘要

内脏反位是一种罕见的先天性异常,可导致腹部器官移位,从而引发非典型临床表现,如左侧阑尾炎。急性阑尾炎是右下腹疼痛最常见的原因;然而,其在左侧发生极为罕见,且常导致诊断延迟,若不及时处理,可能会引发严重并发症,如腹膜炎。影像学检查方法,尤其是计算机断层扫描(CT),在解剖学和病理学诊断中起着关键作用,从而指导适当的手术治疗。我们报告一例67岁患者,有回盲部结核、心肌梗死和缺血性中风病史,因左下腹疼痛入院,最初怀疑是乙状结肠炎所致。CT扫描显示内脏反位伴高位左侧阑尾炎,提示需紧急进行腹腔镜检查。手术探查证实为盲肠后阑尾炎,腹腔积液极少,遂行阑尾切除术。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c129/11899566/0df141ad0670/rjaf130f1.jpg

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