An atypical clinical presentation of acute appendicitis in a young man with midgut malrotation

Pinto, Antonio; Raimondo, Domenico Di; Tuttolomondo, Antonino; Fernandez, Paola; Caronia, A.; Lagalla, Roberto; Arnao, Valentina; Law, Robert; Licata, Giuseppe

doi:10.1016/j.radi.2005.10.010

Cited by 14 publications

(11 citation statements)

References 16 publications

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“…2 Other cases of acute appendicitis on intestinal malrotation presenting for Left lower quadrant pain have been reported. [5][6][7][8] In our case, an Alvarado score of 4 and a nonconclusive abdominal U/S made the diagnosis of acute appendicitis less likely. But the persistence of pain and the increasing inflammatory parameters in her blood exams pushed the medical team to further investigate and a CT scan revealed intestinal malrotation with acute appendicitis.…”

Section: Discussionmentioning

confidence: 55%

Unusual case of acute appendicitis with left upper quadrant abdominal pain

Tawk

Zgheib

Mehanna

2012

International Journal of Surgery Case Reports

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Section: Discussionmentioning

confidence: 55%

Unusual case of acute appendicitis with left upper quadrant abdominal pain

Tawk

Zgheib

Mehanna

2012

International Journal of Surgery Case Reports

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“…Intestinal malrotation is a rare congenital anomaly comprising non-rotation and incomplete rotation of the primitive intestinal tube around the axis of the superior mesenteric artery. In adults the diagnosis is usually incidental, based on investigation carried out for other reasons (25)(26)(27).…”

Section: Discussionmentioning

confidence: 99%

A rare case of perforation of the subhepatic appendix by a toothpick in a patient with intestinal malrotation: laparoscopic approach

Grassi¹

2016

GCHIR

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Acute appendicitis is one of the most common surgical diseases presented by patients in the emergency unit, it affects about 7% of the Western population, the mortality rate is estimated to be around 0.2-0.4% (1). Typical presentation is represented by periumbilical pain radiating to the right lower quadrant of the abdomen with peritoneal reaction on palpation, fever and anorexia. However atypical clinical presentations have been reported such as back pain, pain in the lower quadrants of the abdomen (2) especially in the case of situs inverus (3), pain in the left flank or in the left hypochondrium, in the case of intestinal malrotation (4). Appendicitis results from infection (60%), coprolites (35%), parasites (3%), strictures and tumors (1%) and foreign bodies. Acute appendicitis due to the ingestion of foreign bodies is a rare event, but widely described in the literature. Klinger et al. reported that ingested foreign bodies account for the 0.0005% of the aetiology of acute appendicitis (5). Complications related to the ingestion of foreign bodies are obstruction, perforation, hemorrhage, and fistula. The majority of the ingested foreign bodies pass through the esophagus and through the gastrointestinal tract without complications, however, the risk of perforation increases when long and sharp objects, such as toothpicks, are ingested (6). This case report is extremely interesting both for the peculiarity and rarity of the disease and for the therapeutic approach chosen. Case presentationA 65-year-old man was admitted under emergency to the Department of Digestive Surgery and Liver Unit, St. M. Hospital, Terni, with a 2 days history of lower abdominal pain and fever.Physical examination revealed generalized tenderness and rigidity of the abdominal walls especially in the right hypochondrium with torpid peristalsis. Laboratory blood analysis were in the range, including hepatic function; a neutrophilic leukocytosis was present. Abdomen ultrasound revealed the gallbladder and bile duct within limits without gallstones, a subhepatic cecum without SUMMARY: A rare case of perforation of the subhepatic appendix by a toothpick in a patient with intestinal malrotation: laparoscopic approach.

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“…Birth defects of gastrointestinal tract constitute a frequent morbidity in children and a rather less common pathology in adults [1]. These birth defects include atresia of the small intestine and colon, abnormal rotation and fixation of the primitive gut, anorectal abnormalities, and intestinal duplications.…”

Section: Discussionmentioning

confidence: 99%

“…Intestinal malrotation is a defectin or an incomplete rotation of the mid gut that results in a shortened mesentery with a displaced Treitz ligament and cecum [1]. This rotation defect complicates with mid gut volvulus in case malrotation stopsat 180˚ [2] or could be asymptomatic if it stops at 90 giving rise to a complete common mesentery which rarely complicates hence explaining its fortuitous discovery on radiological imaging done for other indications.…”

Section: Discussionmentioning

confidence: 99%