Situs inversus totalis (SIT) is an entity in which there is transposition of both the abdominal and thoracic organs. Presentation of acute abdomen in a case of SIT poses a challenge to the treating surgeon. We present a rare case report in which we identify the role of laparoscopy in confirming acute appendicitis with a simultaneous left paraovarian hemorrhagic cyst as a cause of left iliac fossa pain.

A 17-year-old female presented with pain in the left lower abdominal quadrant. Ultrasonography and computed tomography confirmed a left-sided inflamed appendix and a left paraovarian hemorrhagic cyst along with transposition of other organs. A diagnostic laparoscopy was done to confirm the diagnosis with subsequent appendectomy and cyst enucleation as a definitive treatment for left iliac fossa pain.

Management of acute abdomen in a case of SIT can be challenging, keeping in mind the transposed organs and also that the nervous supply may still be normal in up to 50% of the cases. The role of diagnostic laparoscopy is pertinent in arriving at diagnosing and treatment of the underlying pathology or pathologies as in our case.

Deolekar SS, Mohare D, Sharma A. Management of Acute Appendicitis and Left Paraovarian Cyst in a Case of Situs Inversus Totalis by Laparoscopy. World J Lap Surg 2017;10(2):73-76.