Presentation
Lower abdominal pain.
Patient Data
Age: 40 years
Gender: Female
From the case:
Acute appendicitis, heterotaxy syndrome
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Heterotaxy syndrome: Right polysplenia, right stomach, right pancreas, midline liver and gallbladder, IVC crosses left of midline to intrahepatic segment.
Small and large bowel have some degree of malrotation, although normal relationship with SMV and SMA is preserved.
Cecum is in the midline pelvis with dilated, thick-walled and inflamed appendix with appendicolith at the base.
Case Discussion
Typical appearance of acute appendicitis made more interesting due to heterotaxy syndrome with polysplenia/left isomerism. This is a good reminder that patients with variant anatomy may have different presentations of acute abdominal pain due to differences in position of abdominal organs.
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