The left sided mystery: Situs inversus totalis

Rajeshwari

Senior Staff Nurse, Kauvery Hospital, Salem, Tamil Nadu

Background

The incidence of situs inversus totalis is generally reported as 1 in 8,000 births (Medscape). Situs inversus totalis is a rare condition where the major visceral organs are reversed or mirrored from their normal position.

A 30-year-old male, presented with an unusual clinical history of pain in the left lower abdomen, initially mimicking diverticulitis or renal colic. However, further investigations revealed an unexpected diagnosis — situs inversus totalis, a mirror-image reversal of normal anatomy. Consequently, the appendix was located on the left side and was found to be inflamed.

The patient was diagnosed with acute appendicitis and required emergency surgical intervention. He had a significant past history of childhood COPD and was on regular medications, placing him at high risk for general anesthesia. In view of this, the anesthetist opted for laparoscopic appendicectomy under spinal anesthesia.

After careful preparation, spinal anaesthesia was administered – a gentle hum of reassurance as the patient drifted into comfort, conscious yet calm, the anaesthesia confirmed an adequate block up to the level of T6, ensuring the patient felt no pain only mild pressure at most.

The surgeon prepared and started a surgery, made a small supra umbilical incision for 10mm telescopic post dis a diagnostic laparoscopy (every organ lay opposite to expectation). The liver glowed golden on the left, the spleen rested comfortably on the right side.

After two 5mm ports followed one in the left iliac fossa and another in the supra pubic region. The camera panned to the Left Lower quadrant.

Dissection began – Gentle, deliberate. The Meso appendix was grasped and coagulated with bipolar energy, its vessels were sealed. The Appendiceal base was identified and looped with No 1 vicryl Endo loop suture it was secured and elegance. With a precise snip, the appendix was freed. Appendicectomy done. 5mm telescope changed and specimen was retrieved through the supra umbilical port. The peritoneal cavity was irrigated with warm saline. Field was clear, achieve homeostasis and free from any hidden objects. The pneumo peritoneum was released slowly. Ports and skin closed with Absorbed sutures.

The operating time totally 8 minutes. From all team coordination we achieve that surgery in risky patient.

As the Anaesthetist lightened the block, the patient smiled faintly – awake, pain free.

Everyone in the Operation Theatre shared a knowing glance a story not just of surgery, but of anatomical wonder and clinical fitness.

Course of hospitalization

Postoperative period was uneventful. Patient was shifted to ICU for observation watched for tachyphemia and any respiratory complications. On POD 1 patient was stable hemodynamically and shifted to ward. On POD 2 patient was symptomatically improved hence discharged as per consultant.

Discharge advice

Tab. Cefupop, Cap. Sompraz, Tab. Zerodol P

Nebulization and breathing exercise

Conclusion

Situs inversus totalis is a fascinating example of human anatomical variation. Although it may be associated with certain health risks, many individuals with this condition live without significant complications. The diagnosis is typically established through imaging modalities such as X-rays, computed tomography (CT), or magnetic resonance imaging (MRI), which demonstrate the mirror-image positioning of internal organs. Awareness and understanding of situs inversus totalis are crucial for healthcare providers to ensure accurate diagnosis and appropriate management. However, this condition poses a significant challenge during clinical evaluation and surgical intervention, particularly in emergency settings.

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