title: Unusual presentation of left sided acute appendicitis in elderly male with asymptomatic midgut malrotation.
abstract: BACKGROUND
  Acute appendicitis in the setting of midgut malrotation is uncommon. Midgut malrotation commonly presents within the first month of life. A minority remain asymptomatic and may present with concomitant abdominal pathology making diagnosis difficult.
  
  
  METHODS
  This paper reports a rare case of a 73-year-old male diagnosed with acute appendicitis and asymptomatic MM .The patient underwent a laparoscopic appendectomy, but had an unplanned return to theatre for washout of post-operative intra-abdominal haematoma.
  
  
  CONCLUSIONS
  Midgut malrotation is commonly described by the stringer classification and type 1a is the most common in adults. There have only been a handful of documented cases of acute appendicitis with midgut malrotation occurring in the adult population. Previous delay in diagnosis has led to a delay in definitive management. Both laparoscopic and open surgery has been used in the past.
  
  
  CONCLUSIONS
  Acute appendicitis with malrotation should be considered in elderly patients presenting with atypical signs and symptoms. Imaging offers significant advantage for timely and definitive management.
authors.affiliation: University of New South Wales, Kensington, NSW, Australia; Fairfield Hospital, Fairfield, NSW, Australia. Electronic address: animesh.singla@gmail.com.
authors.forename: Animesh A
authors.initials: AA
authors.lastname: Singla
authors.affiliation: Fairfield Hospital, Fairfield, NSW, Australia.
authors.forename: Joshua
authors.initials: J
authors.lastname: Rajaratnam
authors.affiliation: University of New South Wales, Kensington, NSW, Australia; Bankstown Hospital, Bankstown, NSW, Australia.
authors.forename: Apresh A
authors.initials: AA
authors.lastname: Singla
authors.affiliation: Fairfield Hospital, Fairfield, NSW, Australia.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Wiltshire
authors.affiliation: Fairfield Hospital, Fairfield, NSW, Australia.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Kwik
authors.affiliation: Fairfield Hospital, Fairfield, NSW, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Smigelski
authors.affiliation: Southwest Colorectal Surgeons, Liverpool, NSW, Australia; Fairfield Hospital, Fairfield, NSW, Australia.
authors.forename: Mathew J
authors.initials: MJ
authors.lastname: Morgan
keywords: Acute appendicitis; Atypical; Embryology; Midgut malrotation