Laparoscopic Appendectomy for Torsed Appendix Presenting as an Acute Abdomen in an Infant Female

BACKGROUND: Torsion of an otherwise normal appendix vermiformis is exceedingly rare and usually presents with symptoms consistent with acute appendicitis. We present the unusual case of an infant girl who was admitted with right lower quadrant pain and focal peritonitis who was found to have appendiceal torsion on laparoscopy. CASE REPORT: An 11-week-old girl was brought to the emergency department with a 48-hour history of abdominal pain, emesis, low-grade fever, and focal right lower quadrant tenderness. Sonography found a noncompressible distended appendix in the right lower quadrant. Upon laparoscopy, a torsed, necrotic appendix vermiformis was found. Appendectomy was performed, and the patient recovered uneventfully. CONCLUSION: In an infant girl with lower abdominal pain, the differential diagnosis should include torsed appendix besides more common causes, such as torsed ovary, intussusception, or small bowel volvulus. Ultrasound is useful for planning the operative approach.