Incidental finding of complete situs inversus in a polytraumatized adult

Abstract

Background: Situs inversus is a rare abnormality typically posing a diagnostic dilemma during routine evaluation of acute abdominal emergencies such as in acute appendicitis and cholecystitis. It is rare to detect such in the setting of trauma. Objective: To report an incidental finding of complete situs inversus in a poly-traumatized adult. Methods: T h e clinical records of the patient including preoperative evaluation, intra-operative findings and postoperative care were reviewed. Result: A 53-year-old man presented with difficulty breathing, left sided chest pain, generalized abdominal pain and distension 18 hours after a vehicular road traffic accident. Examination revealed feature s of left sided hemothorax, absent heart sounds, generalized peritonitis and limb injuries. Plain chest radiograph confirmed left hemothorax with dextrocardia. He had a left closed thoracostomy tube drainage and exploratory laparotomy which revealed complete situs inversus of intra-abdominal organs alongside a jejunal perforation which was repaired. Postoperative recovery was uneventful. Conclusion: Complete situs inversus is uncommon and may not be anticipated in evaluation of trauma patients. Preoperative clinical and radiological evaluation may however be helpful in making a pre-operative diagnosis and further management.