Intestinal malrotation is a rare disorder that is usually diagnosed in infancy or childhood. In adults, it can manifest with a broad range of symptoms, ranging from acute abdomen to vague abdominal complaints, or it may be discovered incidentally during investigation or laparotomy for unrelated disease. Among types of intestinal malrotation, it is rare for the appendix to be rotated into the subhepatic space “upside-down appendix”.
An 83-year-old woman underwent laparoscopic cholecystectomy for gallstones. During intraperitoneal lavage, the appendix was found to be in the subhepatic space. Review of preoperative abdominal computed tomography (CT) showed that the cecum and appendix had rotated into the subhepatic space. Postoperative barium enema examination confirmed that the appendix was located in the right upper quadrant of the abdomen.
With advances in imaging and surgical techniques, asymptomatic malrotation is being detected with increasing frequency. An atypically located appendix can manifest with atypical presentation, which may result in misdiagnosis. Clinicians should be aware that the appendix can have an atypical location.
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Watanabe, M., Takagaki, T. & Iitsuka, Y. Upside-Down Appendix: Report of a Rare Case. Hellenic J Surg 90, 212–214 (2018). https://doi.org/10.1007/s13126-018-0473-z
- Subhepatic appendix
- intestinal malrotation