Left lower quadrant pain of unusual cause

The differential diagnosis of left lower quadrant abdominal pain in an adul t man includes, among others, sigmoid diverticulitis; leaking abdominal aor tic aneurysm; renal colic; epididymitis; incarcerated hernia; bowel obstruc tion; regional enteritis; psoas abscess; and in this rare instance, situs i nversus with acute appendicitis. We report a case of situs inversus totalis with left-sided appendicitis and a brief review of the literature, There w ere several subtle indicators of total situs inversus present that were mis sed by the physicians and surgeons who initially evaluated the patient prio r to surgery. Computed tomography scan with contrast, however, revealed the diagnosis immediately, and treatment was successfully initiated. (C) 2001 Elsevier Science Inc.