Appendicitis with Atypical Location Owing to Malrotation: A Case Report

Abstract

Malrotation of the midgut (the mid-intestine) is an anomaly, which presents with an abnormal peritoneal fixation during its rotation around the superior mesenteric artery. A 27-year-old male patient was admitted to our emergency service with complaints of abdominal and right shoulder pain, nausea, anorexia and vomiting. Rebound tenderness in the right upper and lower abdominal quadrants along with right costovertebral angle tenderness were detected on physical examination. Radiologic signs consistent with perforated appendicitis were detected by abdominal computed tomography. The patient was operated with a diagnosis of perforated appendicitis on the second day of hospitalization; he underwent appendectomy with drainage of the abscess. The patient was discharged from the hospital on the third postoperative day without any complication. In the present case, acute appendicitis with a concomitant intestinal malrotation, which is rarely symptomatic in adults, is discussed according to the findings of imaging modalities. The patient, who reached maturity without having any symptoms of malrotation, presented with different clinical picture because of the atypical localization of the cecum. Therefore, the presence of malrotation may delay the diagnosis during diagnostic work-up and may increase the morbidity.