A Rare Case of Left Sided Acute Appendicitis in a Patient With Asymptomatic Malrotation

Introduction/Purpose: Midgut malrotation is a disease process that is often cared for by pediatric surgeons but is not often seen in the adult population. It is often repaired with a Ladd's procedure to treat or prevent a torsion. We present an interesting case of 28 year old male who presented with left sided acute appendicitis due to his previously undiagnosed malrotation.

Methods or Case Description: Our patient is a 28 year old healthy male who presented to the emergency department with periumbilical and left sided abdominal pain which had been ongoing for 2 days.  While in the emergency department, workup was significant for CT abdomen/pelvis with IV contrast which showed malrotation of the bowel and the appendix was located in the left lower quadrant with surrounding acute inflammation.

The patient was taken to the operating room. While there the abdomen was explored, with the findings of malrotation that were known from the pre operative CT scan. The appendix was located in the left lower quadrant. The appendectomy was completed without any issue. We elected to leave the malrotation alone as it had not caused the patient any symptoms in the past.

Outcomes: Our patient did very well. Post operatively he was observed in the hospital overnight and discharged home on post operative day one after tolerating a regular diet. He was seen for a two week post operative visit and was doing extremely well at that time.

Conclusion: It is important to review all imaging prior to surgery as it can greatly impact surgical planning. In our case, we altered position of our laparoscopic ports significantly to be able to complete our operation.