2013 Volume 33 Issue 7 Pages 1189-1193
An 8-year-old girl presented to our hospital for abdominal pain, vomiting, and fever. She exhibited guarding in the midline of the lower abdomen. Laboratory examination revealed an increased white blood cell count and C-reactive protein level. A conclusive diagnosis could not be reached with abdominal ultrasonography. Enhanced multidetector-row computed tomography (MDCT) showed that the colon was localized to the left side of the abdomen and that the small intestine had shifted to the right. The superior mesenteric artery was running along the right side of the superior mesenteric vein, opposite to its expected position. A swollen vermiform appendix was detected in the mid-lower abdomen. Emergency laparotomy was performed under the diagnosis of acute appendicitis with intestinal malrotation. The intraoperative findings were consistent with gangrenous perforated appendicitis and the cecum was observed to be in the midline of the abdomen. We performed drainage and an appendectomy. The preoperative diagnosis of acute appendicitis with intestinal malrotation is often difficult because abdominal pain presents at atypical sites. MDCT enabled us to determine the correct diagnosis and the proper skin-incision site in this patient.
