Acute Appendicitis in a Patient With Intestinal Malrotation

A 49-year-old woman presented with pain in the lower abdomen and fever that had been developing over the previous 20 h. On examination, pain was observed in the left iliac fossa and hypogastrium, without guarding. Lab work showed leukocytosis with neutrophilia and elevated acute phase reactants. Abdominal ultrasound was ordered, but the appendix was not observed. Computed tomography demonstrated the small intestine in the right hemiabdomen and the large intestine in the left hemiabdomen (Fig. 1), with the pelvic cecum (2) and anterior appendix (1) showing signs that were compatible with acute appendicitis (Fig. 2). Laparoscopic appendectomy was performed. The patient progressed satisfactorily and was discharged on the following day. c i r e s p . 2 0 1 4 ; 9 2 ( 8 ) : e 4 7