A Case Report : A Rare Case of Left Sided Acute Appendicitis

ABSTRACT: The presence of a malrotation of the midgut in adults is identified in asymptomatic patients most commonly as an incidental finding during a workup for an unrelated disease. This report is a rare case of acute ruptured appendicitis in a patient with non-rotation of the midgut. A 30-year -old man was referred to our Institution due to left lower abdominal pain. The radiological examination, particularly computed tomography (CT) of the abdomen, revealed acuteruptured appendicitis accompanied by left-sided cecum. Emergency surgery revealed a ruptured appendix located in the middle area of the lower abdomen with periappendiceal abscess and non-rotation of the midgu. In this case, the atypical position of the appendix led to confusion regarding the diagnosis and to a more invasive surgical intervention. Acute appendicitis is one of the most common conditions requiring emergency surgery. However, acute appendicitis presenting with left lower quadrant abdominal pain is extremely rare. Due to the ambiguity of symptoms, diagnosis is often challenging and thus may lead to an increase in morbidity and mortality. Due to the abnormal cecal and appendix position, diagnosis of acute appendicitis becomes more difficult, thus leading to diagnostic and operative intervention delays. Imaging, particularly CT, plays an important role in establishing an accurate and prompt diagnosis , as delay in diagnosis may occur due to lack of uniformity in the clinical signs and symptoms. Our aim is to highlight the diagnostic challenges in this clinical scenario.

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