Primary Torsion of the Vermiform Appendix and Undescended Cecum Treated by Video-Assisted Transumbilical Appendectomy

Abstract

Torsion of the vermiform appendix is a rare cause of appendicitis that is clinically indistinguishable from the classical presentation. In this paper, we present the first report in the literature of an appendicular torsion associated with an undescended cecum. A 3-year-old male patient with persistent pain in the right hypochondrium and peritoneal irritation underwent diagnostic laparoscopy, finding necrosis of the vermiform appendix caused by torsion of its base associated with an undescended cecum located in an indurated area of the subhepatic region. A video-assisted transumbilical appendectomy was performed. 839

Appendiceal torsion associated with undescended caecum: a case report and review of the literature

“…In reviewing the English literature a total of 30 cases have been reported in adults, including our case (see table 1). Another 16 cases have been reported in paediatric patients 2. A review of the adult cases reveals that this condition affects both genders in similar proportion (18 women vs 16 men) and the age ranges at presentation from 18 to 78 with a mean of 40.8 years.…”

“…Suggested predisposing factors include anatomic variations such as (1) long, fan-shaped meso-appendix with a narrow base; (2) the absence of azygotic folds that normally laterally fix the appendix and (3) caecal malposition. In addition, the use of laxatives and vigorous physical exercise or abnormal peristaltic bowel movements have been suggested to predispose to appendiceal torsion 2 10–12. It is interesting to note that in our case there was a caecal malposition, a long appendix and a history of vigorous physical exercise.…”

“…In 1918, Payne1 reported the first case of appendiceal torsion. Since then about 34 have been described in the adult population and another 16 in the paediatric population 2. Diagnosis of the torsion is invariably made intraoperatively.…”

Subhepatic appendicitis: a diagnostic dilemma

“…In 1955, King2 reported the first case of subhepatic appendicitis due to non-descent of the caecum. Since then, only a few isolated cases have been described in the literature 3 4. There have been reports of intestinal mal-rotation rather than non-descent of the caecum as a cause of this anatomical variant 5 6.…”

Laparoscopic Treatment of Vermiform Appendix Torsion

“…From the first description by Payne in 1918, approximately 17 cases have been reported in children so far. [1][2][3][4] We report a case torsion of the VA which was managed laparoscopically.…”