Appendicitis in a patient with situs inversus totalis

Background: An 18-year-old female presented with mild fever and persisting severe left lower quad- rant abdominal pain for 2 days. Further anamnesis revealed progressive nausea and anorexia. There was no history of previous trauma or relevant medical history. Her last menstruation was 3 weeks before the symptoms started and she had had no sexual intercourse. The most notable abnormality upon physical examination was sharp tenderness at pressure in the left lower abdominal quadrant. Laboratory results showed increased inflammatory parameters (C-reactive protein of 60 mg/ml and white blood cell count of 21 × 103/μL). B-mode ultrasonography (US) and contrast-enhanced CT scan of the abdomen were performed.