Student Presenter(s): Anisa Raidah, Faiz Syed, and Nolberto Jaramillo
Faculty Mentor: Dean Olsen, DO
School/College: Osteopathic Medicine, Old Westbury

Background: Situs inversus totalis (SIT) is an extremely rare condition in which there is complete reversal of both the thoracic and abdominal organs. Left-sided appendicitis (LSA) is also rare and has been previously reported in the literature to occur in association with SIT, midgut malrotation, and an abnormally long right sided appendix. Case Presentation: A 40-year-old male presented to the emergency department with complaints of acute severe left lower quadrant (LLQ) abdominal pain, nausea and vomiting. He was hemodynamically stable, with LLQ tenderness to palpation and no guarding or rebound tenderness. Laboratory studies and CT scans were remarkable for leukocytosis and SIT with left-sided appendicitis. The patient was managed surgically and recovered well. Discussion/Conclusion: Appendicitis was not initially considered in this patient due to the atypical location. This discrepancy in location can lead to delay in diagnosis of this surgical emergency and increased morbidity associated with undiagnosed appendicitis, thus clinicians should be aware of this rare pathology. This rare case of left-sided appendicitis in a patient with SIT highlights the importance of including it in the differential diagnosis of acute left lower quadrant abdominal pain.