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\begin{document}

\title{Left sided appendicitis due to situs inversus totalis}



\author[1]{Yuki Otsuka}%
\author[2]{Ruiko Hayashi}%
\author[2]{Shinichi Urano}%
\author[2]{Akihide Yashima}%
\author[2]{Yasuo Nanba}%
\author[3]{Fumio Otsuka}%
\affil[1]{Okayama University Hospital}%
\affil[2]{Kosei General Hospital}%
\affil[3]{Okayama Daigaku - Shikata Campus}%


\vspace{-1em}



  
  \date{May 08, 2024}


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\emph{Clinical Image}

\textbf{Left sided appendicitis due to situs inversus totalis}

Yuki Otsuka, M.D. \textsuperscript{1,2}, Ruiko Hayashi,
M.D.\textsuperscript{2}, Shinichi Urano, M.D., Ph.D.
\textsuperscript{3}, Akihide Yashima, M.D. \textsuperscript{3}, Yasuo
Nanba, M.D.\textsuperscript{3}, Fumio Otsuka, M.D., Ph.D.
\textsuperscript{1}

\textsuperscript{1} \emph{Department of General Medicine, Okayama
University Graduate School of Medicine, Dentistry and Pharmaceutical
Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan}

\textsuperscript{2} \emph{Department of Internal Medicine, Kosei General
Hospital, 2-5-1 Enichicho, Mihara, 723-0015, Japan.}

\textsuperscript{3} \emph{Department of Surgery, Kosei General Hospital,
2-5-1 Enichicho, Mihara, 723-0015, Japan.}

\textbf{Key words:} situs inversus totalis, appendicitis, diagnosis,
image

\textbf{Word count:} 197 words

\textbf{Disclosure:} The authors declare no conflicts of interest in
association with this study.

\textbf{Corresponding author:}

Name: Yuki Otsuka, M.D.

Affiliation: Department of General Medicine, Okayama University Graduate
School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama,
Japan.

Mailing address: 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan

Phone number: +81-86-235-7342, Fax number: +81-86-235-7345

E-mail address:\emph{otsuka@okayama-u.ac.jp}

\textbf{Key Clinical Message}

Situs inversus may mimic the pain localization of acute abdomen.
Patients with acute abdomen, especially in elderly patients who are
medically healthy, physicians should cautiously diagnose in combination
with the imaging studies.

\textbf{Case presentation}

An 87-year-old woman medically healthy presented with abdominal pain.
Although she was diagnosed with dextrocardia in her young age, she did
not declare it on admission. Abdominal tenderness localised to the left
lower quadrant, which corresponded to McBurney's point was revealed;
however, on the left side. Laboratory tests showed leukocytosis
(8,700/\selectlanguage{greek}µ\selectlanguage{english}L) and elevated C-reactive protein (17.4 mg/dL). Computed
tomography scanning revealed transposition of all viscera and left-sided
swollen appendix with fecolith and mesenteric panniculitis
(\textbf{Figure} ). She underwent laparoscopic appendectomy under the
diagnosis of acute appendicitis and was discharged from the hospital 10
days later.

Unusual pain localization in situs inversus mimic the diagnosis of acute
abdomen\textsuperscript{1}. That is because patients of situs inversus
totalis may not be aware of it themselves, or if they know, may forget
to declare it due to good prognosis in cases without heart defects or
other underlying diagnoses. Moreover, appendicitis with situs inversus
does not always simply demonstrate opposite left lower abdominal pain
owing to the nervous system occasionally not displaying the
corresponding transposition although the viscera are
transported\textsuperscript{2}. In patients with acute abdomen,
especially in elderly patients who are medically healthy, physicians
should cautiously diagnose in combination with the imaging studies.

\textbf{Funding}

None.

\textbf{Acknowledgements}

None.

\textbf{Authors' Contribution}

YO: contributed to the clinical management of the patients, wrote the
first draft, and managed all the submission process. RH, SU, AY, and YN
contributed to the clinical management of the patient and revised the
manuscript. FO revised the manuscript.

\textbf{References}

1. Matsuura H, Hata H. Opposite Murphy's Sign. Gastroenterology. 2018;
156:879-80.

2. Akbulut S, Ulku A, Senol A, et al. Left-sided appendicitis: Review of
95 published cases and a case report. World J Gastroenterol. 2010;
16:5598-602.

\textbf{Figure Legend}

Axial and coronal images of abdominal computed tomography. In addition
to the transposition of all viscera, left sided swollen appendix with
fecolith and mesenteric panniculitis (\textbf{arrow} ) is observed,
which is consistent with appendicitis.

\textbf{Hosted file}

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