Acute Appendicitis as an Incidental Diagnosis of Situs Inversus Totalis: A Case Report and Literature Review.

Acute appendicitis in patients with situs inversus totalis (SIT) represents a diagnostic challenge because the clinical presentation frequently differs from the classic right lower quadrant pain pattern. We present the case of a 37-year-old male with acute appendicitis associated with previously undiagnosed SIT, identified incidentally during diagnostic imaging. The patient presented with left lower quadrant abdominal pain, leukocytosis, and localized tenderness. Computed tomography revealed dextrocardia and left-sided inflammatory changes compatible with acute appendicitis in the setting of SIT. Laparoscopic appendectomy was successfully performed with modified port placement according to the reversed anatomy, with favorable postoperative recovery. This case highlights the importance of considering anatomical anomalies in patients presenting with atypical abdominal pain. Imaging studies, particularly computed tomography, play a crucial role in establishing an early diagnosis and preventing complications such as perforation or generalized peritonitis. Furthermore, laparoscopy offers both diagnostic and therapeutic advantages in patients with situs inversus. Awareness of this uncommon entity is essential for surgeons and emergency physicians in order to avoid delays in diagnosis and treatment.