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. 2014;5(2):76-8.
doi: 10.1016/j.ijscr.2013.12.005. Epub 2013 Dec 12.

An unusual presentation of perforated appendicitis in epigastric region

Mehmet Odabasi  1 , Cem Arslan  2 , Hasan Abuoglu  2 , Emre Gunay  2 , Mehmet Kamil Yildiz  2 , Cengiz Eris  2 , Erkan Ozkan  2 , Ali Aktekin  2 , M A Tolga Muftuoglu  2
Affiliations

An unusual presentation of perforated appendicitis in epigastric region

Mehmet Odabasi et al. Int J Surg Case Rep. 2014.

Abstract

Introduction: Atypical presentations of appendix have been reported including backache, left lower quadrant pain and groin pain from a strangulated femoral hernia containing the appendix. We report a case presenting an epigastric pain that was diagnosed after computed tomography as a perforated appendicitis on intestinal malrotation.

Presentation of case: A 27-year-old man was admitted with a three-day history of epigastric pain. Physical examination revealed tenderness and defense on palpation of epigastric region. There was a left subcostal incision with the history of diaphragmatic hernia repair when the patient was 3 days old. He had an intestinal malrotation with the cecum fixed at the epigastric region and the inflamed appendix extending beside the left lobe of liver.

Discussion: 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.

Conclusion: 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.

Keywords: Diaphragmatic hernia; Epigastric; Laparoscopy; Malrotation; Perforated appendicitis; Unusual presentation.

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Figures

Fig. 1
Fig. 1
Abdominal plain films demonstrated colonic air at epigastric and left upper quadrant.
Fig. 2
Fig. 2
(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.
Fig. 3
Fig. 3
The appearance of the appendix, which was inflamed and perforated.
Fig. 4
Fig. 4
Appendectomy was performed.
See this image and copyright information in PMC

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