Torsion of vermiform appendix: case report and review of the literature

Abstract

Background: Torsion of the vermiform appendix is a rare disease with symptoms very similar to those of acute appendicitis. We herein report a case of torsion of the vermiform appendix diagnosed by intraoperative findings.

Case presentation: A 4-year-old boy presented to our hospital because of abdominal pain and vomiting. Laboratory data revealed a C-reactive protein level of 0.08 mg/dL and white blood cell count of 19,300/μL (neutrophils, 88.9%). Abdominal ultrasound showed a target sign-like finding in the ileocecal region. A computed tomography scan showed swelling of the appendix. We performed an emergency operation under suspicion of acute appendicitis. Laparoscopic examination showed that the appendix had twisted 720° in the clockwise direction. Appendectomy was performed, and the postoperative course was uneventful.

Conclusions: Although torsion of the vermiform appendix is a very rare disease and difficult to differentiate from appendicitis, an inappropriate treatment plan could lead to necrosis and perforation of the appendix. It is important to consider this disease as a differential diagnosis in patients with right lower abdominal pain.

Keywords: Appendicitis; Torsion; Vermiform appendix.

Fig. 1

Ultrasonography of the abdomen. a Axial view of the base of the appendix showed target sign-like appearance. b Longitudinal view showed pseudo-kidney sign

Fig. 2

Computed Tomography scan of the abdomen. Swollen appendix (arrow) can be seen

Fig. 3

Laparoscopic finding. The appendix was twisted 720° clockwise direction

Fig. 4

Histopathological findings of the appendix (Hematoxylin & Eosin staining). Mononuclear cell infiltration was observed mainly in serosa rather than mucosa, indicating that the possibility of acute appendicitis is low. There was no evidence of neoplasia. (a, original magnification:×40; b, original magnification:×400)