Appendicitis in the setting of undiagnosed non-rotation of t
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A 32-year-old male presented with a history of three-day left sided abdominal pain. The pain was initially generalized, then later localized to the left iliac fossa with associated fevers, vomiting, anorexia, and constipation. Examination elicited generalized peritonism, with rebound tenderness worst in the left iliac fossa, and positive psoas sign.

Variation in the locality of tenderness and uncertain diagnosis required further investigation; a computed tomography scan of abdomen and pelvis. Imaging demonstrated marked dilatation of the appendix and periappendiceal fat stranding, confirming acute appendicitis. Non-rotation of the midgut was also noted, with the appendix and cecum was located in the left lower quadrant and the majority of small bowel seen on the right side of the abdomen. No bowel obstruction was present. The patient was commenced on intravenous antibiotics and preceded to a theatre for emergency appendicectomy.

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