# Recurrent Intestinal Obstruction Secondary to Crohn’s Disease in Dextrocardia With Situs Inversus Totalis: A Case Report

## TL;DR

A patient with undiagnosed mirror-image anatomy experienced recurring intestinal blockage due to Crohn’s disease, highlighting the challenges in diagnosing abdominal issues in such cases.

## Contribution

This case report emphasizes the diagnostic challenges of Crohn’s disease in patients with situs inversus totalis and the importance of early imaging.

## Key findings

- Recurrent small bowel obstruction was diagnosed in a patient with situs inversus totalis.
- Histopathology and symptoms suggested Crohn’s disease as the underlying cause.
- Early cross-sectional imaging is critical for accurate diagnosis and surgical planning in such cases.

## Abstract

Situs inversus totalis (SIT) is a rare congenital anomaly characterized by complete mirror-image transposition of the thoracic and abdominal organs. Although most individuals with SIT remain asymptomatic, acute abdominal pathology can pose significant diagnostic and surgical challenges due to reversed anatomical landmarks. Intestinal obstruction is an uncommon but serious complication in this population.

We report the case of a 46-year-old male with no prior knowledge of SIT who presented with a six-month history of intermittent abdominal pain, vomiting, and watery diarrhea, with recent worsening. Two months prior, he had been admitted for partial small bowel obstruction that was resolved with conservative management. Computed tomography (CT) during the current admission revealed recurrent small bowel obstruction with multiple dilated loops, distal ileitis, and mirror-image anatomy consistent with SIT. Initial conservative therapy again failed, prompting diagnostic laparoscopy with lysis of adhesions. The patient subsequently developed recurrent high-grade small bowel obstruction complicated by a pelvic abscess requiring exploratory laparotomy with resection of 25 cm of inflamed ileum and appendectomy. Histopathologic findings and chronicity of symptoms raised a strong suspicion for Crohn’s disease as the underlying etiology, and the patient was discharged with gastroenterology follow-up for further evaluation and management.

This case highlights the diagnostic complexity of acute abdominal conditions in patients with SIT and emphasizes the importance of early cross-sectional imaging for accurate diagnosis and operative planning. Awareness of reversed anatomy and consideration of underlying inflammatory etiologies are essential to avoid delays in management and optimize patient outcomes.