Painful Appendix Without Appendicitis: A Rare Presentation of Gut Malrotation

Intestinal malrotation is a rare congenital condition that occurs due to the developmental failure of mesenteric rotation. In adults, it can be either symptomatic or asymptomatic. Acute symptoms may include intestinal obstruction resulting from a volvulus, which can lead to perforation and sepsis. Chronic symptoms might consist of abdominal pain and loss of appetite, which can ultimately result in weight loss. In this report, we describe a case of an incarcerated ventral hernia in a patient who was incidentally diagnosed with malrotation through computed tomography (CT) imaging. The CT scan revealed that the cecum was located in the midline, with the duodenum positioned on the right side of the abdomen, a typical presentation for this condition. The CT scan further confirmed the presence of a ventral hernia containing an incarcerated omentum and a threatened loop of small bowel. However, the intraoperative findings were surprising. Instead of containing omentum or a loop of small bowel, the hernia contained the abnormally positioned appendix and cecum due to malrotation. The appendix appeared to mimic the small bowel, while the mesoappendix resembled the omentum, as seen on the CT scan. This case may be unique as it presents gut malrotation with an incarcerated and painful appendix within a ventral hernia.