ACUTE APPENDICITIS: AN ATYPICAL PRESENTATION AS LEFT LOWER QUADRANT PAIN IN SETTING OF UNDIAGNOSED INTESTINAL MALROTATION WITH ASSOCIATED VASCULAR ANOMALIES AND LEFT ISOMERISM.

Harris Saeed, Ahmad Murtaza, Farooque Ahmed Haidari, Najam Uddin, Zia Salman Faruqui

Abstract


Acute appendicitis is one of the most frequent causes of acute right lower quadrant abdominal pain requiring emergency surgical intervention. Clinical examination and routine blood tests are sufficient for a provisional diagnosis, with CT scan as the most sensitive modality for diagnostic confirmation. Rare instances of appendicitis presenting as epigastric or left quadrant pain in cases of undiagnosed intestinal malrotation particularly in adults may present as a diagnostic dilemma and may at times even progress to catastrophic outcome. We report a case of 39 years old male patient with undiagnosed intestinal malrotation presenting with a recent history of left lower quadrant pain where acute appendicitis and associated left isomerism and aberrant vascular anomalies were ultimately grasped on the abdominal CT examination.


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References


Lupiañez-Merly C, Torres-Ayala SC, Morales L, Gonzalez A, Lara-Del Rio JA, Ojeda-Boscana I. Left upper-quadrant appendicitis in a patient with congenital intestinal malrotation and polysplenia. The American Journal of Case Reports. 2018;19:447.

Yasin AL, Sh'aban AH, Yousaf A, Toffaha A, Jaleel ZT. Acute Appendicitis Presenting As Epigastric Pain Due to Incomplete Intestinal Malrotation. Cureus. 2021 May 18;13(5).

Coulier B. Asymptomatic left isomerism with preduodenal portal vein: computed tomography appearance. Surgical and Radiologic Anatomy. 2021 Sep;43(9):1425-9.

Kobayashi H, Kawamoto S, Tamaki T, Konishi J, Togashi K. Polysplenia associated with semiannular pancreas. European radiology. 2001 Sep;11(9):1639-41.

Ito K, Matsunaga N, OGAWA Y, MITCHELL D, FUJITA T, HONJO K. Imaging of congenital abnormalities of the portal veinous system. American journal of roentgenology (1976). 1997;168(1):233-7.

Bider K, Kaim A, Wiesner W, Bongartz G. Acute appendicitis in a young adult with midgut malrotation: a case report. European radiology. 2001 Jul;11(7):1171-4.

Rameshbabu CS, Gupta KK, Qasim M, Gupta OP. Heterotaxy polysplenia syndrome in an adult with unique vascular anomalies: case report with review of literature. Journal of radiology case reports. 2015 Jul;9(7):22.

Cupers S, Linthout CV, Desprechins B, Rausin L, Demarche M, Seghaye MC. Heterotaxy syndrome with intestinal malrotation, polysplenia and azygos continuity. Clinics and Practice. 2018 Jan 8;8(1):1004.

Odabasi M, Arslan C, Abuoglu H, Gunay E, Yildiz MK, Eris C, Ozkan E, Aktekin A, Muftuoglu MT. An unusual presentation of perforated appendicitis in epigastric region. International Journal of Surgery Case Reports. 2014 Jan 1;5(2):76-8.

Welte FJ, Grosso M. Left-sided appendicitis in a patient with congenital gastrointestinal malrotation: a case report. Journal of Medical Case Reports. 2007 Dec;1(1):1-4.


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