Missed diagnostic clues and intraoperative discovery of situs inversus totalis in an adult trauma patient: A case report

Situs inversus totalis is a rare congenital anomaly that may remain undetected until imaging or surgery. We report a previously healthy 50-year-old male twin who presented with polytrauma and haemodynamic instability after a road traffic collision. He had left pneumohaemothorax, blunt abdominal trauma with peritonitis, and a closed right femoral fracture The patient’s haemodynamic instability and the need for urgent resuscitation and surgical intervention limited the time available for a complete preoperative assessment, while incorrect left–right labelling of the chest radiograph obscured recognition of dextrocardia. At laparotomy, mirror-image abdominal anatomy was discovered incidentally, with the spleen on the right and the liver, gallbladder, and appendix on the left. The spleen was shattered, and a jejunal perforation was also identified. Right-sided splenectomy, jejunal repair, and incidental appendicectomy were performed. Postoperative imaging confirmed dextrocardia, and recovery was uneventful. This case highlights the importance of correct radiographic labelling, focused examination, and intraoperative adaptability when unexpected anatomy is encountered.