A CASE OF ACUTE APPENDICITIS PRESENTING WITH LEFT LOWER ABDOMINAL PAIN ASSOCIATED WITH MALROTATION OF THE INTESTINE

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  • 左下腹部痛で発症した腸回転異常を伴った急性虫垂炎の1例

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Malrotation of the intestine are seen mostly in infants presenting with upper gastrointestinal obstruction. It is an important entity in the pediatric surgery. In the meantime, malrotation of the intestine is rarely encountered in adults and often detected accidentally in patients under treatment for any other disease. This paper describes our recent experience of the disease in an adult patient with acute appendicitis which we had difficulty in diagnosis due to the presence of malrotation of the intestine.<br> A 66-year-old man was seen at the hospital because of left lower quadrant pain. Under a suspicion of diverticulitis of the sigmoid colon, the patient was conservatively treated. However, the abdominal pain was intensified, and abdominal CT revealed an abscess beneath the abdominal wall in the left lower quadrant. The patient was diagnosed with intraabdominal abscess due to perforation of the intestine and was operated on. During operation, malrotaion of the intestine was confirmed and the appendix was located at the left lower quadrant which perforated at the root forming the abscess in a space surrounded by the ileocecal region, sigmoid colon, and abdominal wall. Since the inflammation at the ileocecal region was severe, the ileocecal region was resected and the Ladd ligament was separated for the malrotation of the intestine.

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