Left Upper-Quadrant Appendicitis in a Patient with Congenital Intestinal Malrotation and Polysplenia

A unique case of epigastric appendicitis: a case report

Intestinal malrotation is a congenital condition that affects ⁓1 in every 6000 live births in which the intestines undergo abnormal rotation during early embryonic development that leads to the unusual positioning of the cecum and appendix. This abnormal placement can complicate the diagnosis of appendicitis for healthcare providers, and serious complications can result if the condition is not identified and managed promptly. This case report aims to present a rare presentation of appendicitis and to highlight the importance of understanding this congenital abnormality.

Delayed Presentation of Malrotation after Infancy: A Systematic Review Based on Clinical Presentations, Associated Anomalies, Diagnosis, and Management

Need and Purpose of Review

Approximately 75% of patients with classic malrotation and midgut volvulus present in neonatal age-group; another 15% may present up to one year. In these, the diagnosis is made because of typical presentation. However, there are many cases in which malrotation has been detected after infancy. In-spite of the variable case reports and studies in literature, there is no specific data on the incidence of malrotation after infancy, its presentation and management guidelines. With this systematic review, we aim to coalesce these findings from various individual case reports and studies.

Methods Used for Collecting and Analysing Data

This systematic review was performed as per the PRISMA (preferred reporting items for systematic review and meta-analyses) guidelines. The authors conducted thorough searches in databases like PubMed/MEDLINE, SCOPUS, Google Scholar and Web of Science for relevant articles. Studies were reviewed for clinical presentation and outcome for malrotation diagnosed beyond infancy.

Main Conclusions

Clinical presentation of malrotation after infancy can be acute as well as chronic; acute presentation being common under 2 years of age and chronic symptoms present as age increases. Sudden onset of abdominal pain and bilious vomiting are commonest acute symptoms and intermittent episodes of recurring vague abdominal pain associated with vomiting and diarrhoea are the commonest chronic symptoms. The diagnostic modalities vary from UGI Contrast series to USG with colour Doppler and CECT scan. Management is operative open as well as laparoscopic Ladd's procedure is being favoured.

A Rare Case of Congenital Intestinal Malrotation Presented as an Intestinal Obstruction in an Adult

Malrotation of the midgut is generally considered a pediatric pathology. Adults are not usually diagnosed early, which occasionally causes delays in both diagnosis and treatment. Therefore, while dealing with patients of any chronological age with abdominal complaints, a strong index of suspicion is necessary. A midgut developmental defect known as intestinal malrotation occurs when the intestines fail to fix in the peritoneal cavity and rotate normally around the superior mesenteric artery during fetal development. Usually, it's rare to have malrotation in adults. When they are symptomatic, operational procedures are typically necessary. Even if the patient is asymptomatic, a Ladd's treatment is indicated if real malrotation is detected or discovered accidentally. In adults, intestinal malrotation rarely shows symptoms and is typically accidentally discovered. We present a unique case of a 24-year-old male who had acute abdominal pain, confirming midgut rotation with the presence of characteristic Ladd's bands on a preoperative computed tomography scan. No signs of intestinal volvulus were present. The patient had an exploratory laparotomy. This case emphasizes the rarity of intestinal malrotation and the debates about how to treat it in the adult population. It also highlights how crucial it is to properly monitor patients who present with ill-defined abdominal pain and maintain a high index of suspicion.