Acute appendicitis in intestinal malrotation. Case report

Abstract

Intestinal malrotation is a congenital abnormality of the intestine's embryological rotation, which develops: Ladd's bands or a narrow mesenteric base, predisposing to gastrointestinal obstruction. It is estimated that more than 90% of patients will present in the first 12 months of life. In newborns, malrotation presents with acute obstruction or volvulus; however, it may go unnoticed in some patients. The treatment of choice for intestinal malrotation is elective surgery, with the Ladd procedure, by laparoscopy or open surgery, in which duodenal fibers are cauterized. As for the management of asymptomatic patients, prophylactic surgical correction is recommended in children's case and observation in adults, since the acute presentation in these is infrequent. In an acute presentation in adults, emergency laparotomy is required to determine the cause and avoid the intestine's necrosis. A case of the acute surgical abdomen due to acute appendicitis is presented in a 27-year-old female patient with intestinal malrotation, with initial clinical presentation of diffuse abdominal pain, lumbar pain, positive lumbar percussion fist, which finally reached an adequate resolution and a good prognosis.