A Rare Case of Intestinal Non Rotation in an Adult Presenting with Acute Appendicitis

Non rotation of the gut is a rare pathological condition that frequently remains asymptomatic in adults and is only identified on incidental imaging. It may result in the delay of diagnosis of several common conditions; due to an atypical presentation. It tends to be identified in the paediatric population, because it is diagnosed secondary to an intestinal obstruction or volvulus. Here we present the case of a 49 year old patient who presented to the Emergency room with left lower quadrant tenderness. Initially, thought to be diverticulitis, however, a diagnostic CT scan of our patient revealed malrotation of the gut with the caecum in the left iliac fossa and duodeno -jejunal flexure and small bowel loops predominantly on the right. It revealed a dilated appendix with a distended lumen in the left mid lower quadrant of the abdomen with associated fat stranding. We proceeded with a laparoscopic appendectomy and a decision to not reverse the non-rotation of the gut. The purpose of this case report is to highlight an uncommon presentation of a common condition and to prevent delayed diagnosis.