1EL WASSI Anass, 2EL KINANI Siham, 3BRAHMI Soufiane, 4ETTAOUSSI Abdelhak, 5KAMAL Khadija, 6MAJD Abdessamad, 7BOUALI Mounir, 8EL BAKOURI Abdelillah, 9EL HATTABI Khalid
1,2,3,4,5,6,7,8,9Department of general surgery, IBN ROCHD University hospital of Casablanca, Casablanca, Morocco
ABSTRACT:
This case report presents a rare and complex instance of acute appendicitis in a 49-year-old male patient, whose clinical and radiological findings mimicked a small bowel obstruction caused by volvulus on an incomplete common mesentery. The patient exhibited diffuse abdominal pain, vomiting, and obstipation, with CT imaging revealing small bowel distension, a whirlpool sign, and inversion of the superior mesenteric artery (SMA) and vein (SMV) suggesting the diagnosis of a volvulus on an incomplete common mesentery. Exploratory laparotomy uncovered a perforated appendix sealed off by the sigmoid colon and a perforated jejunal loop 20 cm from the ileocecal junction, with an unusual appendiculo-jejunal fistula suggestive of possible underlying inflammatory bowel disease (IBD), such as Crohn’s disease. Surgical management included an appendectomy, resection of the perforated jejunum, and ileostomy. This case underscores the diagnostic challenges posed by atypical appendicitis.
KEYWORDS :
Atypical acute appendicitis, Appendiculo-jejunal fistula, atypical small bowel obstruction.
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