Laparoscopic Appendectomy for Left-Sided Acute Appendicitis in Situs Inversus Totalis: A Case Report and Technical Considerations

Left-sided acute appendicitis is an exceptionally uncommon presentation, most often associated with congenital anomalies such as situs inversus totalis (SIT), and may contribute to diagnostic delays. A 31-year-old man presented with a two-day history of migratory abdominal pain localized to the left lower quadrant, with nausea, vomiting, and anorexia. He was hemodynamically stable without leukocytosis. Contrast-enhanced CT demonstrated SIT and an inflamed appendix in the left lower quadrant (approximately 11 mm), with periappendiceal fat stranding and a small volume of free fluid, without pneumoperitoneum. Laparoscopic appendectomy was performed using modified team positioning and port placement to accommodate the mirrored anatomy. Recovery was uncomplicated, and histopathology confirmed acute appendicitis with periappendicitis and no malignancy. Appendicitis should be considered in the differential diagnosis of left lower-quadrant pain; CT supports timely diagnosis in SIT, and laparoscopy is safe and effective when anatomic and ergonomic factors are anticipated.