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Primary acute torsion of the vermiform appendix
J F Val-Bernal1, C González-Vela, M F Garijo
1Anatomical Pathology Department, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria, Santander, Spain.
Summary
Primary acute appendiceal torsion is a rare cause of acute abdomen in children. This case highlights an unusually long appendix in a pediatric patient, contributing to a rare diagnosis.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
Background:
- Appendicitis is a common surgical emergency, but primary appendiceal torsion is a rare differential diagnosis.
- Acute appendiceal torsion involves the twisting of the appendix, leading to ischemia and potential necrosis.
Observation:
- A 6-year-old boy presented with symptoms mimicking acute appendicitis.
- Intraoperative findings revealed an abnormally long appendix (13.5 cm) that had undergone torsion.
Findings:
- Literature review identified 19 cases of primary acute appendiceal torsion, 11 in pediatric patients.
- Torsion typically occurs >1 cm from the appendiceal base, with a mean rotation of 580 degrees, often anticlockwise.
- The appendix is frequently found free-lying or in the pelvic position.
Implications:
- Recognizing appendiceal torsion is crucial for accurate diagnosis and timely surgical intervention in pediatric acute abdomen.
- The anatomical characteristics, such as appendix length and position, may predispose to torsion.
- Further research into this rare condition can improve diagnostic accuracy and patient outcomes.