Twists and turns: A rare case of appendiceal torsion unraveled

Abstract

Vermiform appendix torsion is a rare acute abdominal emergency in the pediatric population, with possibly 25 case reports appearing in English-language publications since 1918, when it was initially described, surgeons mostly accidentally found it during surgery. It can be primary or secondary. Clinical manifestations mimic acute appendicitis. This vermiform appendix torsion is a case report of a 9-year-old girl who had her appendix twisted on itself 360 degrees in an anticlockwise direction. A late diagnosis can result in the appendix being gangrenous. We report a case of a 9-year-old girl who presented to the emergency department with abdominal pain, non-bilious vomiting, constipation, and fever. Laboratory data revealed a white cell count of 19,000 per microliter, with 74% neutrophils. Abdominal Ultrasound was inconclusive. Surgeons performed an emergency laparoscopic exploration with a provisional diagnosis of acute appendicitis. A laparoscopic examination revealed an anticlockwise 360° twist in the appendix. They performed an appendectomy, and the recovery after the procedure went smoothly. Vermiform appendix torsion is a highly uncommon ailment that might be challenging to differentiate from acute appendicitis. Late detection and inappropriate management plans can result in the appendix gangrene and perforation. In pediatric patients with acute abdominal pain, it is critical to consider appendicular torsion as a differential diagnosis.