Appendicitis in adults with incidental midgut malrotation: CT findings.
OBJECTIVE
To report the computed tomography (CT) findings of acute and complicated appendicitis in adults with incidental midgut malrotation.


METHODS
The medical records and CT studies of eight patients with appendicitis and incidental midgut malrotation who presented to two medical centres between 1998 and 2009 were reviewed.


RESULTS
All patients presented with 1-5 days of acute abdominal pain, which was diffuse in two, left-sided in two, lower abdominal in two, and in the right lower quadrant in two patients. The inflamed appendix was right-sided in three, left-sided in three, and in the midline in two patients. Three cases were complicated by a peri-appendicular abscess, and one patient also had a small bowel obstruction. All patients had a complete non-rotation with right-sided duodenum and jejunum, and left-sided colon. All eight patients had an abnormal superior mesenteric artery-superior mesenteric vein (SMA/SMV) relationship and a dysplastic uncinate process of the pancreas. Urgent surgery was performed in six patients and the remaining two were treated conservatively.


CONCLUSIONS
Altered anatomy in malrotation affects the typical clinical and CT findings of acute appendicitis, therefore delaying diagnosis. When CT shows focal inflammation anywhere within the abdomen, along with an abnormal SMA/SMV relationship, the position of the caecum should be ascertained and acute appendicitis ruled out.
Department of Diagnostic Imaging, Assaf Harofeh Medical Center, Zerifin, Israel. Electronic address: liogonky@yahoo.com.
A
A
Ben Ely
N
N
Gorelik
Y
Y
Cohen-Sivan
R
R
Zissin
L
L
Carpineta
A
A
Osadchy
G
G
Gayer
D015746:Abdominal Pain / Q000000981:diagnostic imaging / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001064:Appendicitis / Q000150:complications / Q000000981:diagnostic imaging*; D004065:Digestive System Abnormalities / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D033162:Incidental Findings; D045822:Intestinal Volvulus / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed