A 63-year-old male patient presenting with left-sided acute appendicitis was diagnosed after purulent material was discovered draining from the appendiceal orifice during an elective colonoscopy on September 24, 2026, according to a case report published by Martim Rente, Arnaldo Machado, Ana Martins, Ines Matias, and Manuel Cavalho in the Cureus Journal of Medical Science. The patient, who initially attributed 24 hours of abdominal pain to bowel preparation, was referred to the emergency department, where computed tomography confirmed the rare combination of acute appendicitis and previously undiagnosed congenital intestinal malrotation.
Clinical Presentation and Incidental Colonoscopic Findings
The patient underwent an elective colonoscopy following a positive fecal occult blood test. During the procedure, clinicians observed purulent material filling the appendiceal orifice, accompanied by mucosal erythema and inflammatory changes. The patient reported lower abdominal pain that began roughly 24 hours prior, which he initially suspected was caused by standard bowel preparation.
Upon transfer to the emergency department, physical examination revealed isolated tenderness in the left iliac fossa without any right-sided abdominal pain or generalized peritoneal irritation. Laboratory results showed no leukocytosis, with a white blood cell count of 8.5 × 10³/µL, 76.1% neutrophils, and an elevated C-reactive protein level of 6.7 mg/dL. His medical history included arterial hypertension, gout, dyslipidemia, and allergic rhinitis, with no prior surgical history.
Radiological Confirmation of Intestinal Malrotation
Because the patient presented with left-sided abdominal pain and unusual endoscopic findings, an abdominal and pelvic computed tomography scan was performed. The imaging revealed intestinal malrotation, showing the colon predominantly positioned on the left side of the abdomen and pelvis. A tubular structure measuring approximately 9 mm proximally—compatible with an inflamed appendix—was identified arising from an abnormally positioned cecum to the left of the midline near the umbilicus, surrounded by mild inflammatory fat stranding.
Did you know? Intestinal malrotation is a congenital condition resulting from incomplete midgut rotation during embryological development. While typically diagnosed in infancy, large computed tomography series cited by Rente et al. demonstrate that a substantial proportion of adults remain completely asymptomatic until the condition is discovered incidentally.
Surgical Intervention and Histopathological Results
Laparoscopy confirmed acute phlegmonous appendicitis without exudate in a left-sided appendix. Histopathological examination confirmed acute phlegmonous appendicitis with focal serositis and transmural neutrophilic infiltration.
Postoperative Recovery
The patient experienced an uncomplicated recovery following the surgery. His surgical wounds healed satisfactorily without early complications, and he was discharged home on the first postoperative day.
Frequently Asked Questions
How common is left-sided acute appendicitis?
Left-sided acute appendicitis is rare and typically associated with congenital anatomical anomalies such as situs inversus totalis or intestinal malrotation, where the cecum and appendix fail to migrate to their normal right-sided positions during embryonic development.
Can colonoscopy be used to diagnose acute appendicitis?
While colonoscopy is not a routine diagnostic tool for acute appendicitis, specific inflammatory indicators—such as mucosal edema, bulging, erythema, and purulent drainage observed directly at the appendiceal orifice—can incidentally reveal the condition during procedures performed for other reasons, as noted by Rente et al.
What imaging is best for diagnosing intestinal malrotation in adults?
Computed tomography (CT) is the primary imaging modality used to evaluate adult intestinal malrotation. CT simultaneously identifies appendiceal inflammation and accurately maps abnormal bowel and cecal positioning.
What was the outcome for the 63-year-old patient?
The patient underwent a successful laparoscopic appendectomy using right-sided working ports, had an uncomplicated recovery, and was discharged on the first postoperative day following histopathological confirmation of acute phlegmonous appendicitis.