Acute appendicitis is a common surgical emergency that may present atypically due to anatomical variations. We report a case of a previously healthy male in his forties presenting with epigastric abdominal pain, vomiting, and fever, initially managed as gastritis. Contrast-enhanced computed tomography (CT) of the abdomen revealed acute appendicitis in the left upper quadrant on a background of previously undiagnosed intestinal malrotation. The patient underwent emergency laparoscopic appendectomy, with intensive perioperative care for septic shock. He ultimately made a full recovery. This case highlights the importance of maintaining a high index of suspicion for acute appendicitis in adults presenting with epigastric pain and illustrates the role of early CT in identifying atypical presentations caused by underlying anatomical variants.
Bhati et al. (Tue,) studied this question.