|Malford T. Pillow, MD||Baylor College of Medicine, Section of Emergency Medicine, Department of Medicine, Houston, TX|
|Christopher Valle, MD||Baylor College of Medicine, Section of Emergency Medicine, Department of Medicine, Houston, TX|
A 37-year-old woman presented to the emergency department with 12 hours of gradually worsening left lower quadrant pain with anorexia, vomiting, and diarrhea. She also reported intermittent fever and chills. On exam, her initial vital signs were 102/68, pulse of 102, respirations 18, temperature of 97.5° F. She was mildly anxious secondary to pain. Abdominal exam revealed a soft abdomen with left lower quadrant tenderness with voluntary guarding and mild rebound tenderness. Pelvic exam and urinalysis were normal. Urine pregnancy test was negative. The WBC returned at 15.3×103/μL with 78% neutrophils. A computed tomography scan was performed and showed a left-sided appendicitis with situs inversus totalis (Figure 1 and and 2).
Situs inversus totalis is a complete mirror reversal of the organs. The yearly incidence of acute appendicitis alone is approximately 1:1000 with approximately 6–7% of the population having appendicitis at some point during their lives. The total incidence of left-sided acute appendicitis is 0.04%, with 0.024% having abdominal viscera situs inversus and 0.016% having situs inversus totalis, as in this patient’s case.1 Her diagnosis of situs inversus was previously undiagnosed. This is only the ninth case report in the literature.
Supervising Section Editor: Sean Henderson, MD
Submission history: Submitted December 9, 2009; Accepted December 14, 2009
Full text available through open access at http://escholarship.org/uc/uciem_westjem
Address for Correspondence: JM. Tyson Pillow, MD, Section of Emergency Medicine, Depart. of Medicine, Baylor College of Medicine, 1504 Taub Loop, Houston, TX, 77030
Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources, and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.
1. Collins D. Seventy-one thousand human appendix specimens: a final reports summarizing 40 years’ study. J Am Proctol. 1963;14:365–81.
2. Nelson M, Pesola G. Left Lower Quadrant Pain of Unusual Cause. J Emerg Med. 2001;20(3):241–5.[PubMed]