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An unusual presentation of perforated appendicitis in epigastric region.

Odabasi M, Arslan C, Abuoglu H, Gunay E, Yildiz MK, Eris C, Ozkan E, Aktekin A, Muftuoglu MA - Int J Surg Case Rep (2013)

Bottom Line: While appendicitis is the most common abdominal disease requiring surgical intervention seen in the emergency room setting, intestinal malrotation is relatively uncommon.When patients with asymptomatic undiagnosed gastrointestinal malrotation clinically present with abdominal pain, accurate diagnosis and definitive therapy may be delayed, possibly increasing the risk of morbidity and mortality.Atypical presentations of acute appendicitis should be kept in mind in patients with abdominal pain in emergency room especially in patients with previous childhood operation for diaphragmatic hernia.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Haydarpasa Numune Education and Research Hospital, Istanbul 34688, Turkey. Electronic address: hmodabasi@gmail.com.

No MeSH data available.


Related in: MedlinePlus

(A) CT shows an intestinal malrotation with the cecum in the epigastric region and the inflamed appendix extending beside the left lobe of liver. (B) The stomach and the spleen were located at the right side of the abdomen.
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fig0010: (A) CT shows an intestinal malrotation with the cecum in the epigastric region and the inflamed appendix extending beside the left lobe of liver. (B) The stomach and the spleen were located at the right side of the abdomen.

Mentions: Abdominal plain films demonstrated colonic air at epigastric region and left upper quadrant. Intestinal malrotation was not considered in the differential diagnosis at that point. No pneumoperitoneum was evident (Fig. 1). With a wide range of differential diagnosis (acute cholecystitis, perforated ulcer, pancreatitis, etc.), the patient had undergone an abdominal ultrasound that was unable to justify his symptoms. There was only minimal fluid in Morison's pouch. Therefore, he had an abdominal CT scan the next day with IV contrast. He had an intestinal malrotation with the cecum fixed at the epigastric region and the inflamed appendix extending beside the left lobe of liver. Patient had a partial situs viscerus inversus. Liver was located at original place, but stomach, spleen and pancreas were at right side of the abdomen under liver (Fig. 2A and B).


An unusual presentation of perforated appendicitis in epigastric region.

Odabasi M, Arslan C, Abuoglu H, Gunay E, Yildiz MK, Eris C, Ozkan E, Aktekin A, Muftuoglu MA - Int J Surg Case Rep (2013)

(A) CT shows an intestinal malrotation with the cecum in the epigastric region and the inflamed appendix extending beside the left lobe of liver. (B) The stomach and the spleen were located at the right side of the abdomen.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921649&req=5

fig0010: (A) CT shows an intestinal malrotation with the cecum in the epigastric region and the inflamed appendix extending beside the left lobe of liver. (B) The stomach and the spleen were located at the right side of the abdomen.
Mentions: Abdominal plain films demonstrated colonic air at epigastric region and left upper quadrant. Intestinal malrotation was not considered in the differential diagnosis at that point. No pneumoperitoneum was evident (Fig. 1). With a wide range of differential diagnosis (acute cholecystitis, perforated ulcer, pancreatitis, etc.), the patient had undergone an abdominal ultrasound that was unable to justify his symptoms. There was only minimal fluid in Morison's pouch. Therefore, he had an abdominal CT scan the next day with IV contrast. He had an intestinal malrotation with the cecum fixed at the epigastric region and the inflamed appendix extending beside the left lobe of liver. Patient had a partial situs viscerus inversus. Liver was located at original place, but stomach, spleen and pancreas were at right side of the abdomen under liver (Fig. 2A and B).

Bottom Line: While appendicitis is the most common abdominal disease requiring surgical intervention seen in the emergency room setting, intestinal malrotation is relatively uncommon.When patients with asymptomatic undiagnosed gastrointestinal malrotation clinically present with abdominal pain, accurate diagnosis and definitive therapy may be delayed, possibly increasing the risk of morbidity and mortality.Atypical presentations of acute appendicitis should be kept in mind in patients with abdominal pain in emergency room especially in patients with previous childhood operation for diaphragmatic hernia.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Haydarpasa Numune Education and Research Hospital, Istanbul 34688, Turkey. Electronic address: hmodabasi@gmail.com.

No MeSH data available.


Related in: MedlinePlus