Small bowel injuries are infrequent after blunt abdominal trauma (1). Although small bowel rupture has been reported to be the third most common injury in blunt abdominal trauma, its overall rate of occurrence after blunt abdominal trauma is 0.7%, which makes it a rare phenomenon (2). Delayed intestinal perforation can be seen after blunt abdominal trauma and is a potentially lethal complication. The surgical literature contains only isolated case reports or anecdotal mention of this phe- nomenon (3-5). The term “peri-appendicitis” implies inflammation of the appendicular serosa with preservation of normal mucosal histology. In most situations, this is a sequel to extra-appendicular sepsis and is likely to benefit from treatment targeted at the underlying pathology. However, the majority of these cases are initially treated for acute appendicitis as clinical distinction between the two con- ditions is difficult (6). Situs inversus totalis refers to a perfect mirror image of the normal physiologic positions of the visceral organs with preservation of anteroposterior relationships. Dextrocardia with situs inversus totalis is a rare condition occuring in approximately 2 per 10,000 live births (7). Delayed small bowel perforation after blunt abdominal trauma in this rare condition would be extreme. We present ileum perforation and peri-appen- dicitis secondary to this in a case with situs inversus totalis. Case report A 29-year-old male patient was admitted to our emer- gency department, complaining of abdominal pain. He had a history of blunt trauma to the left lower quadrant of the abdomen, caused by a wooden block springing from the press machine and hitting him 7 days before. He had pain in this region for 3-4 hours and then the pain stopped. After a period of seven days without any complaints his pain restarted four hours before admittance. No other accompanying complaints (fever, anorexia, nausea, vomiting, discomfort) were reported by the patient. He was conscious and cooperative. His blood pressure, cardiac rhythm and temperature were 120/80 mmHg, 90 pulse/min and 37.1 °C respectively. His physical examination revealed abdominal pain and sensitivity particularly in the left lower region. Abdominal muscular defence or rebound were not observed. Bowel sounds were normo-active. The leuko- cyte count was 6700/mm 3 and other laboratory tests were within normal limits. The air compartment of the Acta Chir Belg, 2009, 109, 234-237 Delayed Small Bowel Perforation Due to Blunt Abdominal Trauma and Peri- Appendicitis in a Patient with Situs Inversus Totalis : A Report of a Case M. Uludag*, B. Citgez*, H. Ozkurt** 2nd General Surgery*, Department of Radiology**, Sisli Etfal Training and Research Hospital, Sisli, Istanbul, Turkey. Key words. Blunt abdominal trauma ; small bowel injury ; situs inversus. Abstract. Background : Delayed intestinal perforation after blunt trauma is very rare. Peri-appendicitis is the serosal inflammation of the appendix, which is generally caused by extra-appendicular sepsis. Our purpose is to present this case with delayed ileum perforation after blunt trauma and peri-appendicitis. Case report : A 29-year-old male patient presented with abdominal pain starting from the left lower region, diffusing to all regions. He had a history of a blunt trauma to the left lower quadrant of the abdomen, caused by a wooden block springing from a press machine seven days before. There were no pathological signs in his first evaluation but at the radiological scanning after 16 hours, free air was detected under the left diaphragm. In the abdomen, CT dextrocardia, situs inversus totalis and minimal free liquid near the caecum was found. At laparotomy, a 0.5 cm perforation was observed, localised at the distal ileum and the appendix was oedematous and hyperaemic, consistent with acute inflammation. Resection of the injured bowel and appendectomy were performed. At the pathological examination, the perforation area was non-specific and peri-appendicitis was found. Conclusion : Delayed postraumatic perforation of the intestine occurs as a result of ischaemia. There is no reported case of a patient with situs inversus totalis. If acute abdomen is the case even with a history of minimal abdominal trauma, delayed intestinal trauma should be considered in the diagnosis. Peri-appendicitis secondary to intestinal perforation, which is a rare condition, should come to mind at the diagnosis.