Small bowel obstruction with situs inversus abdominalis: A case report

INTRODUCTION: Situs inversus abdominalis (SIA) is an uncommon condition that causes intestinal malrotation in the paediatric population as its primary complication (Brown, 2017). Presentations of acute surgical emergencies in adults secondary to SIA are extremely rare (Brown, 2017). PRESENTATION OF CASE: A 38-year-old female with situs inversus abdominalis (SIA) presented with small bowel obstruction (SBO). The patient had a history of a paediatric omphalocele repair. The patient failed conservative management and required surgical intervention including a laparotomy and adhesiolysis without intestinal resection for resolution of her symptoms. DISCUSSION: Only 2 cases of SBO secondary to SIA have been documented in the literature; both resulting in bowel resection with a 50 % mortality rate (Mallick, 2006). This is the third reported case and the only case to avoid bowel ischemia. We attribute this to early presentation by the patient, prompt imaging, careful surgical planning with consultant led surgical intervention and a multidisciplinary team approach to recovery. CONCLUSION: Acute surgical emergencies in patients with congenital anomalies should have a low threshold for imaging and intervention with detailed pre-operative planning and a senior surgeon led approach.