Undescended cecum with accessory right colic artery: a rare case report

Abstract

Midgut malrotation and incomplete rotation are common causes of neonatal intestinal obstruction. At end of 10 week of intrauterine life, cecum will be placed in subhepatic region temporarily and descends to right lower quadrant by eleventh week. Arrest of cecum in subhepatic region or undescended cecum is a rare congenital anomaly of mid gut. Usually, it remains asymptomatic and is diagnosed incidentally. If any pathology occurs in anomalous part, like appendicitis then the diagnosis and treatment will be challenging in all age groups. Variation in blood supply have also been reported with anomalies leading to iatrogenic injuries during colonoscopy and surgeries. Lack of knowledge of these rare variations may lead to delayed diagnosis of appendicitis leading to perforation and surgical emergencies. In the present case, we describe an undescended cecum and its associated variation in branching pattern of superior mesenteric artery.

Left sided appendicitis

“…Right upper quadrant pain is commonly a result of caecal malposition, which has been reported to be present in 6% of patients in some studies 1 . 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 …”

“…1 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 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.…”