Abstract / Summary
Situs inversus totalis (SIT) is a rare congenital laterality disorder characterized by mirror-image transposition of the thoracic and abdominal organs. Although most affected individuals remain asymptomatic, associated abnormalities of intestinal rotation or fixation may predispose selected patients to obstruction or volvulus. Adult presentations are uncommon and may be difficult to recognize because symptoms are often nonspecific and mirror-image anatomy complicates clinical and radiologic interpretation. A 61-year-old woman with SIT and a more than 40-year history of recurrent abdominal pain and constipation developed sudden severe abdominal pain within hours of ingesting magnesium sulfate for colonoscopy preparation. Computed tomography demonstrated small-bowel dilation, a transition point, mesenteric congestion, and focal mesenteric twisting. Emergency laparoscopic exploration showed visceral inversion, extensive intra-abdominal adhesions, congenitally unfixed bowel segments, and a 360-degree clockwise volvulus involving the ileocecal region and small-bowel mesenteric root. The operation was completed through an approximately 8-cm periumbilical midline incision, with detorsion, adhesiolysis, open bowel decompression with evacuation of fecal contents, bowel arrangement, and fixation of the ileocecal region and descending colon to the left abdominal wall. Recovery was uneventful. This case highlights the diagnostic challenge of acute volvulus in an adult with SIT and abnormal intestinal fixation. The close temporal association with magnesium sulfate bowel preparation raises the possibility that rapid osmotic fluid accumulation and altered intestinal activity acted as precipitating circumstances in an anatomically vulnerable bowel; however, causality cannot be established from a single case. Severe or persistent abdominal pain during bowel preparation in patients with longstanding unexplained abdominal symptoms or suspected rotational abnormalities should prompt immediate reassessment.