Patient: Male, 30Final Diagnosis: Torsion of appendixSymptoms: Abdominal pain • anorexia • nauseaMedication: —Clinical Procedure: Laparoscopic appendicectomySpecialty: 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.

/pdf/torsion-of-the-vermiform-appendix-a-case-report-and-review-4k1zf38tbn.pdf

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

A 27-year-old man with a background of well controlled colitis presented with a 12-hour history of central abdominal pain, nausea, vomiting and fever. A diagnostic laparoscopy revealed an extremely large, gangrenous appendix, which had descended into the pelvis posterior to adhesions in the right iliac fossa and was torted 720°. The decision was taken to convert to a lower midline laparotomy and as the base appeared healthy, a standard appendicectomy was performed. The patient recovered well and was discharged after two days. The appendix measured 104mm x 53mm x 51mm. Histology revealed acute haemorrhagic and necrotising appendicitis with foci of impending perforation. There was no malignancy or mucocoele. Acute torsion (or volvulus) of the appendix is an unusual cause of this common general surgical emergency.

/pdf/right-iliac-fossa-pain-from-a-grossly-enlarged-and-torted-9pxhbpkvp8.pdf

Right iliac fossa pain from a grossly enlarged and torted appendix in a patient with known colitis.

Torsion of the vermiform appendix is a rare disorder that causes symptoms similar to those of acute appendicitis. Primary and secondary causes of appendiceal torsion have been reported in the literature. Laparoscopy appears to be the most appropriate modality for diagnosis and treatment where the condition is suspected. To our knowledge this is the first case of appendiceal torsion in an adult causing right upper quadrant pain related to caecal malposition.

/pdf/appendiceal-torsion-associated-with-undescended-caecum-a-3dibec76ph.pdf

Appendiceal torsion associated with undescended caecum: a case report and review of the literature.

Torsion of abdominal and pelvic organs: A review

Torted appendices are a rare occurrence but should be considered when encountering a haemorrhagic congested appendix on laparoscopy. As adhesions are rarely present, laparoscopic excision is usually a feasible option.

/pdf/laparoscopic-management-of-a-torted-appendix-1daukwruwz.pdf

Laparoscopic management of a torted appendix.

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Laparoscopic management of a torted appendix.