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Left-Sided Perforated Appendicitis in an Elderly Man with Intestinal Malrotation: A Case Report
Jose Samaniego-Burneo1,2,3, Jordan Llerena-Velastegui1,2,3,4, Alberto Gordillo-Calero3
1Department of Health Sciences, Center for Health Research in Latin America (CISeAL), Quito, Ecuador.
The American Journal of Case Reports
|November 21, 2025
Summary
Left-sided appendicitis in older adults can signal type I intestinal malrotation. Early diagnosis via imaging and laparoscopic surgery are crucial for preventing complications in elderly patients.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Diagnostic Imaging
Background:
- Left-sided acute appendicitis is uncommon, often linked to congenital anomalies like type I intestinal malrotation.
- In older adults, comorbidities can obscure diagnosis, leading to delays in identifying malrotation-related appendicitis.
Purpose of the Study:
- To report a rare case of left-sided perforated appendicitis in an elderly patient due to type I intestinal malrotation.
- To highlight the diagnostic challenges and importance of early intervention in such cases.
Main Methods:
- A case report of a 67-year-old male with atypical abdominal pain.
- Diagnosis confirmed by contrast-enhanced computed tomography (CECT) and emergency laparoscopy.
- Laparoscopic appendectomy and abscess drainage performed.
Main Results:
- CECT revealed an inflamed, obstructed left-sided appendix and signs of type I intestinal malrotation.
- Laparoscopy confirmed a perforated appendix with abscess, leading to successful laparoscopic appendectomy.
- Patient experienced an uneventful recovery and was discharged on postoperative day 2.
Conclusions:
- Type I intestinal malrotation can present atypically as left-sided perforated appendicitis in advanced age.
- Vigilant review of cross-sectional imaging for malrotation indicators is essential.
- Early laparoscopic intervention is key to reducing morbidity in elderly patients with unusual abdominal pain.
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