Acute appendicitis in an adolescent with situs inversus totalis: a case report

Appendicitis is the most common surgical emergency in pediatrics, being present in 1% to 8% of children with acute abdominal pain. The classical clinical presentation is characterized by the presence of acute migrating abdominal pain in the right iliac fossa. However, in patients with situs inversus totalis, the pain manifests in the left iliac fossa, which may delay the diagnosis and predispose to the development of complications. Thus, the aim of this study is to report a case of appendicitis in an adolescent with situs inversus totalis. METHODS: This study is case report of appendicitis in an adolescent with situs inversus totalis. The research was submitted to the Ethics in Human Research Committee and approved under CAAE number 53591321.0.0000.5237. RESULTS: The incidence of appendicitis in patients with situs inversus totalis is 0.016% to 0.024%. Due to the atypical clinical presentation in these patients, there is a tendency to delay the diagnosis of appendicitis, especially when the situs inversus totalis was not previously identified. Thus, there is a greater risk of developing severe complications such as intestinal perforation and sepsis, which considerably increases morbidity and mortality. CONCLUSIONS: We emphasize the importance of listing appendicitis as a possible diagnosis in patients with acute abdominal pain in the left iliac fossa because of the possibility of situs inversus totalis.