Situs Inversus Totalis in a man with generalised peritonitis secondary to typhoid ileal perforation: A case report

Abstract

Situs inversus totalis (SIT) is a rare congenital condition in which all thoraco-abdominal organs are mirrored from their normal positions, occurring in approximately 1 in 10,000 individuals. Its coexistence with typhoid ileal perforation is exceptionally uncommon and poses unique diagnostic and surgical challenges. We report a 50-year-old Nigerian man who presented with an 18-day history of fever and 5-day history of abdominal pain and distension. Chest X-ray revealed dextrocardia, and a diagnosis of generalised peritonitis secondary to typhoid ileal perforation was made. Emergency exploratory laparotomy confirmed SIT, with two ileal perforations identified proximal to a left-sided ileocaecal junction. Segmental resection and anastomosis were performed with an uneventful recovery. This case highlights the importance of maintaining a high index of suspicion for anatomical anomalies and the value of thorough preoperative imaging in ensuring safe surgical management.