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

Area of Science:

• Gastroenterology
• Surgical Case Reports

Background:

• Acute appendicitis is uncommon with midgut malrotation (MM).
• MM typically presents in infancy, but can remain asymptomatic into adulthood.
• Asymptomatic MM can complicate diagnosis of other abdominal pathologies.

Purpose of the Study:

• To report a rare case of acute appendicitis in an elderly patient with asymptomatic midgut malrotation.
• To highlight diagnostic challenges and management considerations for this rare presentation.

Main Methods:

• Case report of a 73-year-old male.
• Diagnosis of acute appendicitis and asymptomatic midgut malrotation.
• Laparoscopic appendectomy followed by re-operation for intra-abdominal hematoma.

Main Results:

• The patient presented with acute appendicitis and undiagnosed asymptomatic midgut malrotation.
• A laparoscopic appendectomy was performed, complicated by a post-operative hematoma requiring surgical washout.
• This case underscores the rarity of appendicitis in adults with MM.

Conclusions:

• Acute appendicitis with midgut malrotation should be considered in elderly patients with atypical symptoms.
• Imaging plays a vital role in achieving timely and definitive management.
• Stringer classification type 1a is most common in adults, with few documented adult cases of appendicitis and MM.