Left-sided appendicitis in intestinal malrotation

Case contributed by Dr Abdallah Khateeb

Presentation

Fever, leucocytosis and left-sided abdominal pain. Previously healthy. No past surgical history.

Patient Data

Age: 35 year old
Gender: Male
CT

Abdomen and pelvis CT

The large bowel is located in the left hemi-abdomen while the small bowel is on the right side. The caecum is at the left upper quadrant. The SMA/SMV relationship is reversed. These findings are compatible with bowel malrotation.

There is a blind-ending tubular structure at the left upper quadrant originating from the caecum, with wall enhancement and surrounding fat stranding. There are a few prominent regional lymph nodes. Reactive ileus is also seen. 

The combination of findings is compatible with malrotation with a left-sided acute appendicitis.

Case Discussion

This case shows an atypical presentation of acute appendicitis that can be a cause of delayed or missed diagnosis. Due to its abnormal location, the presenting pain was unusual.

Laparotomy was performed accordingly and acute appendicitis was confirmed.

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Case information

rID: 43338
Case created: 5th Mar 2016
Last edited: 8th Aug 2017
Inclusion in quiz mode: Included

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