Torsion of the Vermiform Appendix: A Case Report and Review of Literature

Abstract

Patient: Male, 30

Final Diagnosis: Torsion of appendix

Symptoms: Abdominal pain • anorexia • nausea

Medication: —

Clinical Procedure: Laparoscopic appendicectomy

Specialty: Surgery

Objective:: Rare disease

Background:: Torsion of the vermiform appendix is a rare condition that presents with symptoms analogous to those of common acute appendicitis; therefore, it is often diagnosed during surgery. It was first described by Payne et al. in 1918. Since then, there has been wide recognition of a primary and a secondary form of the condition, affecting both the pediatric and adult populations. We present a case of an adult patient and conducted a literature review in the adult demographic.

Case Report:: We report the case of a 30-year-old man who presented with clinically acute appendicitis. Laparoscopically, we diagnosed a torsion of the vermiform appendix secondary to a mucocele process. Histology confirmed a low-grade mucinous cystoadenoma, with a hemorrhagic necrosis of the wall, in keeping with torsion.

Conclusions:: Torsion of the vermiform appendix is a rare condition that presents similar to acute appendicitis, and therefore is often diagnosed intraoperatively. Since first described, 33 cases in adults were identified in the English literature, and recognition of a primary or secondary form has emerged. Preoperative radiological imaging is rarely useful in diagnosis. To the best of our knowledge, this is the eighth reported case in the English literature of a torsion of the vermiform appendix secondary to a mucinous cystoadenoma.

Keywords: Appendix; Cystadenoma, Mucinous; Torsion Abnormality.

Figure 1.

Laparoscopic view of the appendix mucocele. Arrow pointing to torsion at the base of the appendix.

Figure 2.

Appendix specimen.