Description

A 30-year-old physiotherapist with known Kartagener's syndrome presented with left iliac fossa pain of 2-day duration, associated with nausea and fever. Confirmation of mirror image anatomy and acute left-sided appendicitis was made on CT scan and subsequently at laparoscopy, which were performed with all equipment, staff and ports positioned in a mirror image of the standard approach. The operating surgeon (SB) is ambidextrous, which simplified technical aspects. Laparoscopic views demonstrated abdominal organs placed on the opposite side to our usual expectations; figure 1 shows the liver in the left upper quadrant with the splenic flexure lying on the right, and figure 2 demonstrates the caecum in the left iliac fossa with an inflamed appendix in the centre of the image.

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Figure 1

Liver in the left upper quadrant with the splenic flexure lying on the right.

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Figure 2

The caecum in the left iliac fossa with an inflamed appendix in the centre of the image.

Kartagener's syndrome describes a triad of situs inversus, sinusitis and bronchiectasis, and is thought to be related to cilia dysfunction. Reports of acute appendicitis in Kartagener's syndrome are extremely limited1 and anaesthetic considerations are relevant in this multiorgan disorder. The majority of patients will be aware of their underlying condition at presentation, and a careful medical history is essential in establishing an appropriate differential diagnosis for abdominal pain in these patients. A small minority are diagnosed only intraoperatively, although this is becoming increasingly rare in the context of current preoperative imaging modalities.Although left-sided appendicitis is a rare cause of acute left iliac fossa pain, an awareness of such a possibility is needed, given the significant clinical consequences of missed appendicitis.