Abstract
A 46-year-old man presented with right lower quadrant pain of abdomen revealed a swollen vermiform appendix and an increase in density of periappendicular fatty tissue on an abdominal contrast-enhanced CT scan. He was referred to our hospital with a diagnosis of acute appendicitis. When he was first seen at our hospital, the right lower quadrant pain was already relieved and there were no findings suggestive of perforation. We thus selected conservative therapy with antibiotics and he was admitted to our hospital. However, on the 2nd hospital day, he had recurred and aggravated right lower quadrant pain, so that emergency laparoscopic operation was performed. The surgical findings included an appendix which changed in color to dark violet, absence of perforation, and no pus adhesions to the surroundings. It was confirmed that severe ischemic change had been caused by torsion of the appendix at the root. We thus reduced the torsion and performed appendectomy. Since we successfully conducted appendectomy before appendiceal perforation due to the torsion, his postoperative course was uneventful and he was discharged from our hospital on the 4th postoperative day.
We report a case of torsion of the vermiform appendix in which laparoscopic operation for diagnosis and treatment was useful, with some bibliographic comments.
