An Unsuspected Adult Intestinal Malrotation Presenting With Left-Sided Appendicitis, With the Diagnosis First Suggested by Purulent Drainage From the Appendiceal Orifice During an Elective Colonoscopy.
- 1General Surgery, Unidade de Saúde Local do Alentejo Central, Évora, PRT.
- 2Surgery, Hospital do Espírito Santo de Évora, Évora, PRT.
- 3General Surgery, Hospital do Espírito Santo de Évora, Évora, PRT.
Abstract
Acute appendicitis typically presents with right lower quadrant abdominal pain. Congenital abnormalities of intestinal rotation may alter the position of the cecum and appendix, resulting in atypical clinical manifestations and potentially delaying diagnosis. Intestinal malrotation is usually diagnosed during childhood but may remain asymptomatic and undetected until adulthood. We report the case of a 63-year-old man who underwent elective colonoscopy following a positive fecal occult blood test. He reported abdominal pain beginning approximately 24 hours before the procedure, which he initially attributed to bowel preparation. During colonoscopy, purulent material was observed filling the appendiceal orifice, raising suspicion of acute appendicitis. The patient was referred to the emergency department, where examination revealed isolated tenderness of the left iliac fossa without right-sided abdominal pain. Laboratory evaluation showed no leukocytosis, 76% neutrophils, and an elevated C-reactive protein level of 6.7 mg/dL. Computed tomography demonstrated intestinal malrotation, with the colon predominantly located on the left side of the abdomen and pelvis, and an inflamed appendix arising from the abnormally positioned cecum to the left of the midline. Laparoscopic appendectomy was performed using right-sided working ports. Intraoperative findings demonstrated acute phlegmonous appendicitis without exudate, and histopathological examination confirmed acute phlegmonous appendicitis with focal serositis. The postoperative course was uncomplicated, and the patient was discharged on the first postoperative day. This case illustrates an unusual presentation of acute appendicitis associated with previously undiagnosed intestinal malrotation, in which the initial diagnostic suspicion arose incidentally during colonoscopy. Recognition of anatomical variants and appropriate use of cross-sectional imaging are important when evaluating atypical presentations of common surgical emergencies.
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BibTeX
@article{rente2026unsuspected,
title = {{An Unsuspected Adult Intestinal Malrotation Presenting With Left-Sided Appendicitis, With the Diagnosis First Suggested by Purulent Drainage From the Appendiceal Orifice During an Elective Colonoscopy.}},
author = {Martim Rente and Arnaldo Machado and Ana Martins and Ines Matias and Manuel Cavalho},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.116872},
url = {https://europepmc.org/article/MED/42928852},
note = {CC BY},
}
RIS
TY - JOUR
TI - An Unsuspected Adult Intestinal Malrotation Presenting With Left-Sided Appendicitis, With the Diagnosis First Suggested by Purulent Drainage From the Appendiceal Orifice During an Elective Colonoscopy.
AU - Martim Rente
AU - Arnaldo Machado
AU - Ana Martins
AU - Ines Matias
AU - Manuel Cavalho
PY - 2026
DA - 2026/09/24
JO - Cureus
DO - 10.7759/cureus.116872
UR - https://europepmc.org/article/MED/42928852
AB - Acute appendicitis typically presents with right lower quadrant abdominal pain. Congenital abnormalities of intestinal rotation may alter the position of the cecum and appendix, resulting in atypical clinical manifestations and potentially delaying diagnosis. Intestinal malrotation is usually diagnosed during childhood but may remain asymptomatic and undetected until adulthood. We report the case of a 63-year-old man who underwent elective colonoscopy following a positive fecal occult blood test. He reported abdominal pain beginning approximately 24 hours before the procedure, which he initially attributed to bowel preparation. During colonoscopy, purulent material was observed filling the appendiceal orifice, raising suspicion of acute appendicitis. The patient was referred to the emergency department, where examination revealed isolated tenderness of the left iliac fossa without right-sided abdominal pain. Laboratory evaluation showed no leukocytosis, 76% neutrophils, and an elevated C-reactive protein level of 6.7 mg/dL. Computed tomography demonstrated intestinal malrotation, with the colon predominantly located on the left side of the abdomen and pelvis, and an inflamed appendix arising from the abnormally positioned cecum to the left of the midline. Laparoscopic appendectomy was performed using right-sided working ports. Intraoperative findings demonstrated acute phlegmonous appendicitis without exudate, and histopathological examination confirmed acute phlegmonous appendicitis with focal serositis. The postoperative course was uncomplicated, and the patient was discharged on the first postoperative day. This case illustrates an unusual presentation of acute appendicitis associated with previously undiagnosed intestinal malrotation, in which the initial diagnostic suspicion arose incidentally during colonoscopy. Recognition of anatomical variants and appropriate use of cross-sectional imaging are important when evaluating atypical presentations of common surgical emergencies.
SN - 2168-8184
ER -