Unusual presentation of left sided acute appendicitis in elderly male with asymptomatic midgut malrotation

Animesh A Singla; Joshua Rajaratnam; Apresh A Singla; Stephanie Wiltshire; Charlotte Kwik; Michelle Smigelski; Mathew J Morgan

doi:10.1016/j.ijscr.2015.10.018

Unusual presentation of left sided acute appendicitis in elderly male with asymptomatic midgut malrotation

Int J Surg Case Rep. 2015:17:42-4. doi: 10.1016/j.ijscr.2015.10.018. Epub 2015 Oct 20.

Authors

Animesh A Singla¹, Joshua Rajaratnam², Apresh A Singla³, Stephanie Wiltshire², Charlotte Kwik², Michelle Smigelski², Mathew J Morgan⁴

Affiliations

¹ University of New South Wales, Kensington, NSW, Australia; Fairfield Hospital, Fairfield, NSW, Australia. Electronic address: animesh.singla@gmail.com.
² Fairfield Hospital, Fairfield, NSW, Australia.
³ University of New South Wales, Kensington, NSW, Australia; Bankstown Hospital, Bankstown, NSW, Australia.
⁴ Southwest Colorectal Surgeons, Liverpool, NSW, Australia; Fairfield Hospital, Fairfield, NSW, Australia.

Abstract

Introduction: Acute appendicitis in the setting of midgut malrotation is uncommon. Midgut malrotation commonly presents within the first month of life. A minority remain asymptomatic and may present with concomitant abdominal pathology making diagnosis difficult.

Presentation of case: This paper reports a rare case of a 73-year-old male diagnosed with acute appendicitis and asymptomatic MM .The patient underwent a laparoscopic appendectomy, but had an unplanned return to theatre for washout of post-operative intra-abdominal haematoma.

Discussion: Midgut malrotation is commonly described by the stringer classification and type 1a is the most common in adults. There have only been a handful of documented cases of acute appendicitis with midgut malrotation occurring in the adult population. Previous delay in diagnosis has led to a delay in definitive management. Both laparoscopic and open surgery has been used in the past.

Conclusion: Acute appendicitis with malrotation should be considered in elderly patients presenting with atypical signs and symptoms. Imaging offers significant advantage for timely and definitive management.

Keywords: Acute appendicitis; Atypical; Embryology; Midgut malrotation.