Acute Appendicitis Presenting as Unusual Left Upper Quadrant Pain

Abstract

Appendicitis is the most common abdominal disease that requires surgery in the emergency ward. It usually presents as right lower quadrant pain, but may rarely present as left upper quadrant (LUQ) pain due to congenital anatomical abnormalities of the intestine. We report a patient who complained of persistent LUQ abdominal pain and was finally diagnosed by computed tomography (CT) as congenital intestinal malrotation complicated with acute appendicitis. It is important to include acute appendicitis in the differential diagnosis of patients who complain of LUQ abdominal pain. Abdominal CT can provide significant information that is useful in preoperative diagnosis and determination of proper treatment.

A Rare Case of Perforated Left Upper Quadrant Appendicitis.

“…However, renal ectopia or agenesis are also other congenital anatomical anomalies which are usually associated with malpositioning of specific portions of the bowel. In case of absence of left kidney, as in our patient, the left renal fossa will be occupied by splenic flexure [3], [4] However, in our case the left renal fossa was free and the patient has only the cecum and right colon shifted to the left upper quadrant.…”

A rare case of situs inversus totalis associated with sigmoid diverticulitis and appendicular agenesis. Embryological, clinical considerations and literature review

“…nine articles were selected. Using the same search data and the same exclusion criteria, 20 articles were selected from the Google Scholar ® database [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ].…”

Left sided appendicitis

“…At the end of 10 week of intrauterine life, the caecum is in the subhepatic region temporarily and if arrest of caecum occurs this is generally asymptomatic and diagnosed incidentally 2 . Other intestinal anatomical abnormalities as a result of congenital malrotation – including those associated with dextrocardia and situs inversus – may result in patients presenting with left upper quadrant pain with a left‐sided appendix 3–5 …”

“…2 Other intestinal anatomical abnormalities as a result of congenital malrotationincluding those associated with dextrocardia and situs inversusmay result in patients presenting with left upper quadrant pain with a left-sided appendix . [3][4][5] Internal hernia can cause bowel malposition in a variety of locations. One systematic review reported that approximately 0.5% of patients developed internal hernia after laparoscopic colorectal resection.…”