Feeney Gerard, Hannan Enda, Alagha Mohammed, Abdeldaim Yasser
Department of Surgery, University Hospital Limerick, Limerick, Ireland.
J Surg Case Rep. 2022 Jun 16;2022(6):rjac274. doi: 10.1093/jscr/rjac274. eCollection 2022 Jun.
Intestinal malrotation is a rare clinical entity that occurs in 1/6000 live births. Acute appendicitis (AA) is commonly recognized clinically by migratory right iliac fossa pain. We present a rare case of AA in a patient with previously undiagnosed IM that posed a diagnostic challenge due to abnormal caecal location, which was managed by a laparoscopic approach. The presence of undiagnosed congenital anomalies such as IM can render diagnosis of even seemingly straightforward conditions such as AA challenging, meaning that the presence of classical clinical findings cannot always be relied upon. One should have a low threshold for performing cross-sectional imaging in cases where clinical findings do not yield a satisfactory diagnosis. The adult patient with AA in the context of incidental type 1 IM can be managed laparoscopically by a simple modification of standard technique, without the need to correct malrotation, thus allowing the patient to benefit minimally invasive surgery.
肠旋转不良是一种罕见的临床病症，发病率为1/6000活产儿。急性阑尾炎（AA）临床上通常以转移性右下腹疼痛为特征。我们报告一例罕见的急性阑尾炎病例，患者先前未诊断出肠旋转不良，由于盲肠位置异常，给诊断带来了挑战，该病例采用腹腔镜手术治疗。未诊断出的先天性异常（如肠旋转不良）的存在，即使对于看似简单的病症（如急性阑尾炎）的诊断也具有挑战性，这意味着不能总是依赖经典的临床发现。在临床检查结果不能得出满意诊断的情况下，应降低进行横断面成像检查的阈值。对于偶然发现的1型肠旋转不良合并急性阑尾炎的成年患者，可通过对标准技术进行简单改良，采用腹腔镜手术治疗，无需纠正旋转不良，从而使患者从微创手术中获益。
