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Left-sided appendicitis in a patient with congenital gastrointestinal malrotation: a case report

BACKGROUND: While appendicitis is the most common abdominal disease requiring surgical intervention seen in the emergency room setting, intestinal malrotation is relatively uncommon. When patients with asymptomatic undiagnosed gastrointestinal malrotation clinically present with abdominal pain, accu...

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Autores principales: Welte, Frank J, Grosso, Mario
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2007
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2034390/
https://www.ncbi.nlm.nih.gov/pubmed/17880685
http://dx.doi.org/10.1186/1752-1947-1-92
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author Welte, Frank J
Grosso, Mario
author_facet Welte, Frank J
Grosso, Mario
author_sort Welte, Frank J
collection PubMed
description BACKGROUND: While appendicitis is the most common abdominal disease requiring surgical intervention seen in the emergency room setting, intestinal malrotation is relatively uncommon. When patients with asymptomatic undiagnosed gastrointestinal malrotation clinically present with abdominal pain, accurate diagnosis and definitive therapy may be delayed, possibly increasing the risk of morbidity and mortality. We present a case where CT was crucial diagnostically and helpful for pre-surgical planning in a patient presenting with an acute abdomen superimposed on complete congenital gastrointestinal malrotation. CASE PRESENTATION: A 46-year-old previously healthy male with four days of primarily left-sided abdominal pain, low-grade fevers, nausea and anorexia presented to the Emergency Department. His medical history was significant for poorly controlled diabetes and dyslipidemia. His white blood count at that time was elevated. Initial abdominal plain films suggested small bowel obstruction. A CT scan of the abdomen and pelvis was performed with oral and IV contrast to exclude diverticulitis, revealing acute appendicitis superimposed on congenital intestinal malrotation. Following consultation with the surgical team for surgical planning, the patient went on to laparoscopic appendectomy and did well postoperatively. CONCLUSION: Atypical presentations of acute abdominal conditions superimposed on asymptomatic gastrointestinal malrotation can result in delays in delivery of definitive therapy and potentially increase morbidity and mortality if not diagnosed in a timely manner. Appropriate imaging can be helpful in hastening diagnosis and guiding intervention.
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spelling pubmed-20343902007-10-18 Left-sided appendicitis in a patient with congenital gastrointestinal malrotation: a case report Welte, Frank J Grosso, Mario J Med Case Reports Case Report BACKGROUND: While appendicitis is the most common abdominal disease requiring surgical intervention seen in the emergency room setting, intestinal malrotation is relatively uncommon. When patients with asymptomatic undiagnosed gastrointestinal malrotation clinically present with abdominal pain, accurate diagnosis and definitive therapy may be delayed, possibly increasing the risk of morbidity and mortality. We present a case where CT was crucial diagnostically and helpful for pre-surgical planning in a patient presenting with an acute abdomen superimposed on complete congenital gastrointestinal malrotation. CASE PRESENTATION: A 46-year-old previously healthy male with four days of primarily left-sided abdominal pain, low-grade fevers, nausea and anorexia presented to the Emergency Department. His medical history was significant for poorly controlled diabetes and dyslipidemia. His white blood count at that time was elevated. Initial abdominal plain films suggested small bowel obstruction. A CT scan of the abdomen and pelvis was performed with oral and IV contrast to exclude diverticulitis, revealing acute appendicitis superimposed on congenital intestinal malrotation. Following consultation with the surgical team for surgical planning, the patient went on to laparoscopic appendectomy and did well postoperatively. CONCLUSION: Atypical presentations of acute abdominal conditions superimposed on asymptomatic gastrointestinal malrotation can result in delays in delivery of definitive therapy and potentially increase morbidity and mortality if not diagnosed in a timely manner. Appropriate imaging can be helpful in hastening diagnosis and guiding intervention. BioMed Central 2007-09-19 /pmc/articles/PMC2034390/ /pubmed/17880685 http://dx.doi.org/10.1186/1752-1947-1-92 Text en Copyright © 2007 Welte and Grosso; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Welte, Frank J
Grosso, Mario
Left-sided appendicitis in a patient with congenital gastrointestinal malrotation: a case report
title Left-sided appendicitis in a patient with congenital gastrointestinal malrotation: a case report
title_full Left-sided appendicitis in a patient with congenital gastrointestinal malrotation: a case report
title_fullStr Left-sided appendicitis in a patient with congenital gastrointestinal malrotation: a case report
title_full_unstemmed Left-sided appendicitis in a patient with congenital gastrointestinal malrotation: a case report
title_short Left-sided appendicitis in a patient with congenital gastrointestinal malrotation: a case report
title_sort left-sided appendicitis in a patient with congenital gastrointestinal malrotation: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2034390/
https://www.ncbi.nlm.nih.gov/pubmed/17880685
http://dx.doi.org/10.1186/1752-1947-1-92
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