外科ジャーナル

Intestinal Malrotation and Appendicitis in Adults

Abstract

Lăcrămioara Perianu, Ștefana-Eugenia Moldovanu, Cristina Furnică

Background: Intestinal malrotation is a rare condition resulting from an incomplete midgut rotation and fixation; most of the cases were diagnosed in the newborn and the presentation at adulthood is traditionally considered as rare. In the same time appendicitis is a very common surgical condition with different clinical presentations and the diagnosis can be challenging especially when there is an alteration to the normal position of anatomical structures.

Case report: We present the case of 19 years old patient admitted for diffuse abdominal pain and dyspepsia. The physical exam revealed peri umbilical rebound tenderness. The biochemical tests revealed an inflammatory syndrome, with leucocytosis (WBC at 12,000/mm3) and elevated CRP (62 mg/L). The ultrasound exam was not contributive. A CT scan was performed and revealed the inflammation of ileo-caecal aria and aspect of intestinal malrotation, the common mesentery. An exploratory laparoscopy was performed and confirmed the acute appendicitis and intestinal malrotation. Appendectomy was performed; the postoperative course was uneventful, and the patient was discharged at 3 postoperative days.

Conclusion: The intestinal malrotation in adults is a relatively rare condition and often asymptomatic. On the other hand, appendicitis is a common condition with various clinical presentations; in cases where peritoneal signs were located elsewhere other than the right iliac fossa, surgeons could bear in mind the possibility of underlying intestinal malrotation, as this could be the first presentation of this congenital condition. The laparoscopic approach is feasible and allows the diagnosis of the intestinal malrotation type and treatment of associated condition.