Successful appendectomy for 94-year-old woman with rare situs inversus

(QBĐT) - The Department of General Surgery, Quang Binh General Hospital has just received and successfully treated a special case with a rare diagnosis of appendicitis with complete situs inversus.

Accordingly, Mrs. TTG (94 years old, from Quang Ninh district) was hospitalized with pain in the lower left abdomen lasting more than a week, accompanied by a mild fever. Due to the increasing abdominal pain, her family took her to the hospital for emergency care.

Through clinical examination, the doctor noticed an unusual pain location, the patient had pain localized in the left iliac fossa, different from the usual location of the appendix in the right iliac fossa. Exploring the patient's medical history, the old woman was found to have complete situs inversus, a rare congenital malformation that causes the position of internal organs in the abdomen and chest to be arranged in reverse, the patient's heart and stomach were on the right side, while the liver and appendix were on the left side, completely opposite to normal.

The medical team of the General Surgery Department, Quang Binh General Hospital, has just received and successfully operated on an elderly woman TTG - a special case with a rare diagnosis of appendicitis with complete situs inversus.

Ultrasound results showed that the appendix originated from the cecum in the left iliac fossa, with obvious signs of inflammation. The diameter of the appendix stump was about 9mm, the wall was thick, there was surrounding inflammation, and there was edema of the cecum.

After consultation, the doctors diagnosed the patient with appendicitis on the basis of situs inversus and assessed this as a difficult and complicated surgery, the old woman was assigned an emergency laparoscopic appendectomy.

Because the patient is elderly, the anesthesiologist must be extremely careful during anesthesia. On the other hand, the patient has situs inversus, so when performing surgery, the surgeon will have to perform reverse operations such as reverse trocar port, reverse endoscopic device placement, etc.; at the same time, it requires the surgeon to accurately identify each structure, must have deep expertise and a lot of experience to ensure patient safety.

Furthermore, the patient was elderly and had been in pain for a long time. The inflammation lasted more than a week, causing the appendix to become adherent and difficult to separate, causing many difficulties for the surgeon.

Dr. Le Minh Tinh, the doctor who directly examined and operated on the patient, said: “Sisenteric inversion is a rare condition, accounting for a very small proportion in the community, at a rate of about 0.001% - 0.01%. This is a condition in which the tissues and internal organs in the chest and abdomen are reversed and reflected in the vertical plane compared to their normal position. Anatomically, there will be many risks and difficulties when making a diagnosis.

For appendicitis, when examining clinically, doctors often only examine the right side, ignoring the left side, which can lead to late appendicitis causing peritonitis or appendiceal rupture. Laparoscopic surgery must also be performed in the opposite direction, from the placement of trocars to the arrangement of the machine, and the surgeon's standing posture must all be adjusted to correspond to the reversed anatomical structure.

Situs inversus is a rare condition, occurring in a very small percentage of the population.

After more than 1 hour of surgery, the appendix was successfully separated and removed. The patient's condition is stable, no fever, soft abdomen, no distension, able to defecate, the drainage tube has released little fluid. The patient has now been discharged from the hospital.

Appendicitis is a common surgical emergency that, if not detected and treated promptly, can lead to dangerous, even life-threatening complications. In people with situs inversus—internal organs positioned out of place compared to normal—symptoms may appear on the left side, causing confusion in diagnosis if a careful history is not taken.

Therefore, it is extremely important to clearly understand personal health conditions such as surgical history, congenital malformations, or unusual anatomical features and proactively inform the doctor, helping to guide accurate treatment, avoid missing diseases, and minimize risks during medical intervention.

TTH Quang Binh General Hospital is proud to be one of the trusted medical examination and treatment addresses, always ready to receive and effectively handle complicated cases, contributing to bringing a healthy life to the people. The hospital gathers a team of well-trained, experienced, and highly specialized surgeons. Along with a system of modern and synchronous equipment, such as: Endoscopic surgery system, new generation lithotripsy machine, C-arm scanner, and automatic digestive suturing equipment. Each patient has a separate and appropriate treatment regimen, bringing quick results, helping to save maximum time and costs and bringing peace of mind and satisfaction to patients throughout the treatment process.

Source: https://www.baoquangbinh.vn/suc-khoe/202504/phau-thuat-cat-ruot-thua-thanh-cong-cho-cu-ba-94-tuoi-dao-nguoc-phu-tang-hiem-gap-2225608/