Left-Sided Appendicitis in an Elderly Patient with Midgut Malrotation

Area of Science:

• Gastroenterology
• Surgical Anatomy
• Pediatric Surgery

Background:

• Appendicitis is a common surgical emergency with diverse clinical presentations.
• Midgut malrotation is a rare congenital anomaly often presenting in infancy but can manifest atypically in adults.
• Anatomical variations can complicate appendicitis diagnosis.

Purpose of the Study:

• To report a rare case of appendicitis as the initial presentation of midgut malrotation in an elderly patient.
• To emphasize the diagnostic challenge posed by congenital anomalies in adult appendicitis.
• To highlight the importance of considering midgut malrotation in atypical appendicitis cases.

Main Methods:

• Case report of an elderly patient with left lower abdominal pain and urinary tract infection.
• Diagnostic imaging using abdominal computed tomography (CT).
• Review of relevant literature on midgut malrotation and appendicitis.

Main Results:

• Abdominal CT revealed left-sided appendicitis.
• CT also identified non-rotational type midgut malrotation.
• The patient's presentation mimicked a urinary tract infection, complicating initial diagnosis.

Conclusions:

• Appendicitis can be the presenting symptom of underlying midgut malrotation, even in the elderly.
• Clinicians must consider congenital anatomical anomalies in the differential diagnosis of appendicitis.
• Early recognition of midgut malrotation is crucial for appropriate management and preventing complications.