Perforated Appendicitis in a 52-Year-Old Male With Previously Undiagnosed Intestinal Malrotation: A Case Report.

Intestinal malrotation is a congenital anomaly resulting from abnormal midgut rotation during embryologic development. Although commonly diagnosed in infancy, it may remain asymptomatic until adulthood and is often discovered incidentally. Acute appendicitis in the setting of malrotation may present atypically due to abnormal positioning of the cecum and appendix, potentially leading to delayed diagnosis and increased morbidity. We report a case of a 52-year-old male who presented with left lower quadrant (LLQ) abdominal pain and was found to have perforated appendicitis in the context of previously undiagnosed intestinal malrotation. Computed tomography demonstrated right-sided small bowel, left-sided colon, reversal of the superior mesenteric vessels, and a displaced, inflamed appendix with associated abscess formation. Surgical exploration confirmed malrotation and perforated appendicitis, requiring conversion from laparoscopic to open appendectomy. The postoperative course was uneventful. This case highlights the importance of considering intestinal malrotation in adults presenting with atypical abdominal pain suggestive of appendicitis and emphasizes the critical role of computed tomography in diagnosis and operative planning.