Báo cáo y học: Left-sided appendicitis in a patient with congenital gastrointestinal malrotation: a case report

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Báo cáo y học: " Left-sided appendicitis in a patient with congenital gastrointestinal malrotation: a case report"Journal of Medical Case Reports BioMed Central Open AccessCase reportLeft-sided appendicitis in a patient with congenital gastrointestinalmalrotation: a case reportFrank J Welte* and Mario GrossoAddress: Department of Radiology, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts, USAEmail: Frank J Welte* - fjwelte@gmail.com; Mario Grosso - Mario.GrossoMD@bhs.org* Corresponding authorPublished: 19 September 2007 Received: 2 July 2007 Accepted: 19 September 2007Journal of Medical Case Reports 2007, 1:92 doi:10.1186/1752-1947-1-92This article is available from: http://www.jmedicalcasereports.com/content/1/1/92© 2007 Welte and Grosso; licensee BioMed Central Ltd.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: While appendicitis is the most common abdominal disease requiring surgical intervention seen in the emergency room setting, intestinal malrotation is relatively uncommon. When patients with asymptomatic undiagnosed gastrointestinal malrotation clinically present with abdominal pain, accurate diagnosis and definitive therapy may be delayed, possibly increasing the risk of morbidity and mortality. We present a case where CT was crucial diagnostically and helpful for pre-surgical planning in a patient presenting with an acute abdomen superimposed on complete congenital gastrointestinal malrotation. Case presentation: A 46-year-old previously healthy male with four days of primarily left-sided abdominal pain, low-grade fevers, nausea and anorexia presented to the Emergency Department. His medical history was significant for poorly controlled diabetes and dyslipidemia. His white blood count at that time was elevated. Initial abdominal plain films suggested small bowel obstruction. A CT scan of the abdomen and pelvis was performed with oral and IV contrast to exclude diverticulitis, revealing acute appendicitis superimposed on congenital intestinal malrotation. Following consultation with the surgical team for surgical planning, the patient went on to laparoscopic appendectomy and did well postoperatively. Conclusion: Atypical presentations of acute abdominal conditions superimposed on asymptomatic gastrointestinal malrotation can result in delays in delivery of definitive therapy and potentially increase morbidity and mortality if not diagnosed in a timely manner. Appropriate imaging can be helpful in hastening diagnosis and guiding intervention. dilemma in these patients. Furthermore, a trend may beBackgroundAppendicitis is the most common surgical disease diag- developing where diverticulitis, once a disease primarilynosed in the emergency room setting. Gastrointestinal of older adults, may be becoming more prevalent inmalrotation is, by comparison, relatively uncommon. younger adults [1] and may exhibit a somewhat differentDepending upon the location of the cecum and appendix, demographic and clinical course [2]. This phenomenonpatients with acute appendicitis and malrotation may may further bias a clinician confronted with a middle-present atypically with left-sided abdominal pain. Left- aged patient with an acute abdomen and left-sided symp-sided abdominal pain most commonly raises the diagnos- toms.tic question of possible diverticulitis, creating a diagnostic Page 1 of 4 (page number not for citation purposes)Journal of Medical Case Reports 2007, 1:9 ...