A Pediatric Case of Laparoscopic Appendectomy for Torsion of the Vermiform Appendix

Abstract

Torsion of the vermiform appendix is relatively rare, but sometimes emergency surgery is required because of the risk of necrosis. It should be included in the differential diagnosis of patients presenting with prolonged abdominal pain, especially while waiting for appendectomy. We report a case of laparoscopic appendectomy for torsion of the vermiform appendix in a child. An eight-year-old boy was admitted to our hospital because of prolonged abdominal pain after conservative medical treatment for appendicitis. We describe him as presenting with abdominal tenderness and peritoneal signs, despite a negative inflammatory reaction in a laboratory test. After a course of antibiotics, the abdominal pain disappeared and he was discharged. However, he was admitted again on the next day because of the recurrence of abdominal pain. At the time of laparoscopic surgery, the appendix was twisted anticlockwise by 180° and adhered to the omentum. An appendectomy was performed. The resected specimen of the appendix had a shortened mesoappendix and showed accumulation of serous fluid at the distal tip. A histopathological examination revealed a narrow lumen of the distal appendix, which was thick-walled without neoplastic changes. No recurrence has been observed up to the present.