Left-sided appendicitis in children with congenital gastrointestinal malrotation: a diagnostic pitfall in the emergency department

Left-sided appendicitis in intestinal malrotation: a minimally invasive approach

Intestinal malrotation is a rare clinical entity that occurs in 1/6000 live births. Acute appendicitis (AA) is commonly recognized clinically by migratory right iliac fossa pain. We present a rare case of AA in a patient with previously undiagnosed IM that posed a diagnostic challenge due to abnormal caecal location, which was managed by a laparoscopic approach. The presence of undiagnosed congenital anomalies such as IM can render diagnosis of even seemingly straightforward conditions such as AA challenging, meaning that the presence of classical clinical findings cannot always be relied upon. One should have a low threshold for performing cross-sectional imaging in cases where clinical findings do not yield a satisfactory diagnosis. The adult patient with AA in the context of incidental type 1 IM can be managed laparoscopically by a simple modification of standard technique, without the need to correct malrotation, thus allowing the patient to benefit minimally invasive surgery.

Single-incision laparoscopic appendectomy for treating appendicitis in a patient with gastrointestinal malrotation

INTRODUCTION

Intestinal malrotation is a rare congenital anomaly, and acute appendicitis associated with intestinal malrotation is extremely rare. PRESENTATION OF CASE We report a rare case of a 47-year-old Japanese woman diagnosed with barium-related perforated appendicitis associated with intestinal malrotation. We used a transumbilical single-incision laparoscopic approach to resect the appendix, and the procedure was completed successfully without perioperative complications.

DISCUSSION

To our knowledge, single-incision laparoscopic surgery for appendicitis associated with intestinal malrotation has not been reported yet. In cases with mobile cecum such as this one, mobilization from inflammatory adhesion of the surrounding structures is easy.

CONCLUSION

We conclude that transumbilical single-incision laparoscopic appendectomy is a simple and less invasive method for treating appendicitis associated with intestinal malrotation.