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WJOLS

Management of Acute Appendicitis and Left Paraovarian Cyst in a Case of Situs Inversus Totalis by Laparoscopy

A B
Figs 5A and B: Transposed abdominal organs with spleen in the right hypochondrium: (A) Liver along the left hypochondrium;
and (B) during diagnostic laparoscopy

of single autosomal recessive gene located on the long appendix even if appearing normal may eliminate any
6
arm of chromosome 14. Acute abdomen in SI is a major possibility of misdiagnosis in future. It will also exclude
clinical challenge for surgeons for diagnosing and treat- the risk of complications that come with delayed diag-
ing the pathology. In fact, this is the reason why in 40% nosis, such as appendiceal rupture, which can be fatal in
of cases, the incision for surgical pathology is planned young female patients. 12
inappropriately. 7,8 There is no standard port position for laparoscopic
The differential diagnosis of left lower quadrant pain in appendectomy in SIT patients, and it is placed accord-
SIT patients includes diverticulitis, epididymitis, incarcer- ing to basic principles of laparoscopy and ergonomics. 13
ated or strangulated hernia, bowel obstruction, regional
enteritis, psoas abscess, mesenteric ischemia, right- and CONCLUSION
left-sided acute appendicitis (LSAA), pelvic inflammatory With the case report, the authors wish to suggest that in
disease, endometriosis (in females), and others. 9,10 patients of SI with acute abdomen, the laparoscopy is an
The diagnosis of acute appendicitis in patients with SIT important tool in surgeons’ hand in diagnosing as well
can be based on clinical examination, blood investigations, as in doing definitive management of patient. Even in the
X-rays, USG, electrocardiogram, barium studies, CT scan, circumstances of normal looking appendix, it is better
and diagnostic laparoscopy. However, in SIT with multiple to do appendectomy to avoid future misdiagnosis and
pathologies, cause of symptoms is difficult to correlate and decrease morbidity associated with the same.
in these circumstances, the laparoscopy offers a big role in
diagnosis as well as definite treatment of pathology. Even REFERENCES
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World Journal of Laparoscopic Surgery, May-August 2017;10(2):73-76 75