Pylephlebitis and Hepatic Abscess Secondary to Complicated Appendicitis in a Geriatric Patient With Undiagnosed Situs Inversus Totalis: A Case Report.

Pylephlebitis is an uncommon but severe complication of intra-abdominal infections, particularly associated with conditions such as appendicitis or diverticulitis. Although it is more frequently observed in older men, it can occur in other age groups and carries significant mortality if not diagnosed in a timely manner. Acute appendicitis remains the leading cause of emergency abdominal surgery worldwide, with a higher risk of complications in elderly patients due to diagnostic challenges. Situs inversus totalis, an unusual anatomical condition, may delay diagnosis by altering the clinical location of symptoms. We report the case of a geriatric patient with previously undiagnosed situs inversus totalis who developed complicated appendicitis with pylephlebitis and hepatic abscess, highlighting the clinical and therapeutic challenges of this combination.