A Case Report of Recurrent Appendicitis in a Pediatric Patient with Situs Inversus in a Resource-limited Setting: A Diagnostic and Surgical Challenge

Background: Situs inversus is a rare congenital condition where internal organs are mirrored from their usual positions, presenting a diagnostic challenge, especially in conditions like appendicitis, where pain may occur in atypical locations. Awareness of this condition is vital for timely diagnosis and management. Case Report: We present a case of a 7-year-old Sudanese girl with recurrent abdominal pain in the left iliac fossa, low-grade fever, and loss of appetite. Clinical examination suggested situs inversus, confirmed by imaging, revealing a left-sided appendix with acute inflammation. The patient underwent an open appendectomy, and histopathology confirmed acute appendicitis. She had an uneventful recovery postoperatively. Situs inversus complicates diagnosis due to altered anatomical landmarks, and delayed diagnosis can lead to complications. In resource-limited settings, ultrasound is crucial for preoperative diagnosis, reducing the need for CT scans and minimizing radiation exposure, especially in pediatric patients. While laparoscopic appendectomy is typically preferred, open surgery was chosen in this case due to the patient’s age and complex anatomy. Although situs inversus does not predispose to specific visceral diseases, clinicians must maintain a high suspicion in cases of atypical abdominal pain. Conclusion: Early recognition of situs inversus and appropriate imaging are essential for diagnosing appendicitis in these patients. Surgeons must adapt their approach to accommodate anatomical variations.