Laparoscopic approach in Acute Appendicitis with Situs Visce
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Abdominal pain due to acute appendicitis in one of the most causes of access to Emergency Room requiring surgical consult and treatment. The occurrence of anatomical anomalies should be considered especially when clinical and imaging features are misleading.

Laparoscopic management of patient with acute undifferentiated abdominal pain can be a safe and effective way to confirm uncertain diagnosis.

A case of 23-year-old Caucasian men with mild fever with complain of and persisting severe abdominal pain on the left lower quadrant for 2 days with progressive nausea and anorexia. There was no history of urinary symptoms nor diarrhea. The patient had no other comorbidities. Situs viscerum inversus detected on radiological investigation.
Laparoscopic approach was used to confirm the diagnosis and to perform appendectomy. Trocars placement was tailored for this peculiar case.

One third of patient with acute appendicitis complains abdominal pain in an unexpected location due to various anatomical position of appendix. Left-sided acute appendicitis is a cause of misdiagnosis and it can occur in association with anatomical anomalies such as situs viscerum inversus and midgut malrotation. Laparoscopic surgery may represent a valuable approach in terms of differential diagnosis and treatment in these patients.

It was concluded that Left-sided acute appendicitis should always be considered in young male patients with left lower quadrant pain. Laparoscopic approach is useful and safe procedure both for diagnosis and treatment of these unclear clinical pictures.