Advertisement

Acute Appendicitis Presenting As Acute Gastritis in an Adult Patient with Undiagnosed Congenital Gut Malrotation: A Case Report

      Abstract

      Background

      We report a case of an atypical presentation of acute appendicitis in an adult due to an undiagnosed congenital gut malrotation.

      Objective

      The obvious benefit of observation with serial examinations followed by the use of computed tomography (CT) is discussed in aiding in the diagnosis for atypical presentations of appendicitis.

      Case Report

      A 45-year-old man who presented with epigastric pain and vomiting was diagnosed with acute left-sided appendicitis on CT scan. The patient’s appendix was located in the left lower quadrant of the abdomen due to undiagnosed congenital gut malrotation, thus resulting in an atypical presentation of a common illness.

      Conclusion

      Observation with serial examinations, followed by CT scanning if indicated, is an invaluable strategy to use in diagnosing atypical presentations of common pathology.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Vissers R.J.
        • Lennarz W.B.
        Pitfalls in appendicitis.
        Emerg Med Clin North Am. 2010; 28: 103-118
        • Yeh B.
        Does the adult patient have appendicitis?.
        Ann Emerg Med. 2008; 52: 301-303
        • Wagner J.M.
        • McKinney W.P.
        • Carpenter J.L.
        Does the patient have appendicitis?.
        JAMA. 1996; 276: 1589-1594
        • Rescorla F.J.
        • Shedd F.J.
        • Grosfeld J.L.
        • Vane D.W.
        • West K.W.
        Anomalies of intestinal rotation in childhood: analysis of 447 cases.
        Surgery. 1990; 108 (discussion 715–6): 710-715
        • Dietz D.W.
        • Walsh R.M.
        • Grundfest-Broniatowski S.
        • Lavery I.C.
        • Fazio V.W.
        • Vogt D.P.
        Intestinal malrotation: a rare but important cause of bowel obstruction in adults.
        Dis Colon Rectum. 2002; 45: 1381-1386
        • Kapfer S.A.
        • Rappold J.F.
        Intestinal malrotation-not just the pediatric surgeon’s problem.
        J Am Coll Surg. 2004; 199: 628-635
        • Zissin R.
        • Rathaus V.
        • Oscadchy A.
        • Kots E.
        • Gayer G.
        • Shapiro- Feinberg M.
        Intestinal malrotation as an incidental finding on CT in adults.
        Abdom Imaging. 1999; 24: 550-555
        • Bajwa A.
        • Sheth H.
        • Hughes F.
        Midgut malrotation as a rare cause of chronic abdominal pain: a case report and review of literature.
        Grand Rounds. 2007; 7: 67-69
        • Keith J.C.
        • Thomas J.J.
        • Buday S.J.
        • Price P.D.
        • Smear J.
        Asymptomatic midgut rotational anomalies in adults: 2 case reports and review of the literature.
        J Fam Pract. 2003; 59: 7
        • Gamblin T.C.
        • Stephens Jr., R.E.
        • Johnson R.K.
        • Rothwell M.
        Adult malrotation: a case report and review of the literature.
        Curr Surg. 2003; 60: 517-520
        • Akbulut S.
        • Caliskan A.
        • Ekin A.
        • Yagmur Y.
        Left-sided acute appendicitis with situs inversus totalis: review of 63 published cases and report of two cases.
        J Gastrointest Surg. 2010; 14: 1422-1428
        • in’t Hof K.H.
        • van Lankeren W.
        • Krestin G.P.
        • et al.
        Surgical validation of unenhanced helical computed tomography in acute appendicitis.
        Br J Surg. 2004; 91: 1641-1645
        • Tamburrini S.
        • Brunetti A.
        • Brown M.
        • Sirlin C.
        • Casola G.
        Acute appendicitis: diagnostic value of nonenhanced CT with selective use of contrast in routine clinical settings.
        Eur Radiol. 2007; 17: 2055-2061
        • Hlibczuk V.
        • Dattaro J.A.
        • Jin Z.
        • Falzon L.
        • Brown M.D.
        Diagnostic accuracy of noncontrast computed tomography for appendicitis in adults: a systematic review.
        Ann Emerg Med. 2010; 55: 51-59
        • Israelit S.
        • Brook O.R.
        • Nira B.R.
        • Guralnik L.
        • Hershko D.
        Left-sided perforated acute appendicitis in an adult with midgut malrotation: the role of computed tomography.
        Emerg Radiol. 2009; 16: 217-218
        • Welte F.
        • Grosso M.
        Left-sided appendicitis in a patient with congenital gastrointestinal malrotation: a case report.
        J Med Case Reports. 2007; 1: 92
        • Lee M.R.
        • Kim J.H.
        • Hwang Y.
        • Kim Y.K.
        A left-sided periappendiceal abscess in an adult with intestinal malrotation.
        World J Gastroenterol. 2006; 12: 5399-5400