Introduction: Total situs inversus (TSI) is a rare congenital anomaly characterized by a complete transposition of all abdominal and thoracic viscera. The aim of our study was to describe a rare case of total situs inversus with the appendix on the left discovered during an acute abdominal event, which we discuss in conjunction with data from the literature.

Case Report: a 24-year-old patient was admitted for abdominal pain; vomiting; cessation of stool and gas; and abdominal distension, which had been evolving for a week. The patient's history included bilateral inguinal herniorraphy. Clinical examination revealed a slightly distended abdomen, the site of two bilateral postoperative inguinal scars, soft and painful overall and tympanic. The rectal examination showed an empty rectal ampoule. An abdominal X-ray without preparation revealed hydro-aerial images in the bowel. The patient presented in good general condition with a good color of the skin and conjunctival. TA = 110/70 mmHg; FR = 23 cycles/min, FC = 119 beats/min. The abdominal X-ray without preparation showed images of hydro-aerial small intestines (Figure 1), while the pulmonary X-ray showed dextrocardia. The biological assessment showed a slight disturbance in the ionogram. During surgery, we found a retro-distension of the small bowel loops starting 60 cm from the ileocecal angle where an ileomesenteric band was located, intestinal adhesions and epiplo-parietal adhesions; a sigmoid on the right and a cecum bearing an appendix in the left iliac fossa, with a liver in the left hypochondrium. We performed an appendectomy without burying the stump after sectioning the band and adhesiolysis. The postoperative course was uncomplicated.

Conclusion: total situs inversus with the appendix on the left is a rare congenital anomaly, and its association with intestinal obstruction due to bands is also very rare. Preoperative diagnosis requires a high index of suspicion and is facilitated by imaging. Surgery is the appropriate treatment.