A 23-year-old male patient is admitted in the emergency unit with complaints of acute pain in the left lower quadrant of abdomen, nausea, vomiting and anorexia. Physical examination, shows tenderness in the left lower quadrant, defense and rebound. Laboratory examination reveals a white blood cell count at 18,000 cells/mm3, with 73% neutrophils. His temperature is 38°c. The patient was referred to radiology unit and supine abdominal radiograph showed colonic gas distension in the left side of abdomen. Abdominal computed tomography (CT) examination showed that cecum was not at the normal localization in the left lower-middle part of abdomen. Similar to cecum, ascending colon was also located in the left side of abdomen. The superior mesenteric vein (SMV) was located anterior and to the left of the superior mesenteric artery (Fig. A, thick arrow cecum, thin arrow SMV). At the inferior-medial part of cecum, a tubular, enhancing structure compatible with inflamed appendix was seen. The diameter and wall thickness of appendix were increased additionally there were mesenteric heterogeneity and linear density increases at periappendiceal region (Fig. B, thick arrow appendix, thin arrow periappendiceal heterogeneity). The diameter of the appendix was 9 mm. In the light of these findings the patient was diagnosed as midgut malrotation and additionally left sided acute appendicitis.
The patient was referred to general surgery department for surgery and discharged shortly after.