Left-sided appendicitis in intestinal malrotation
Fever, leucocytosis and left-sided abdominal pain. Previously healthy. No past surgical history.
Abdomen and pelvis CT
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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.
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.