Torsion of vermiform appendix with fecalith: a case report
© Wani et al; licensee BioMed Central Ltd. 2008
Received: 29 April 2008
Accepted: 23 June 2008
Published: 23 June 2008
Torsion of the vermiform appendix is a rare disorder, which causes abdominal symptoms indistinguishable from acute appendicitis and is found by chance during the laparotomy.
We report a case (a 76-year-old male) suffering of torsion of the vermiform appendix with fecalith. It was twisted 540 degrees in an anti-clockwise direction. Appendectomy was done.
Appendiceal torsion may be assocated with the presence of fecalith. This case is the oldest one among the patients with appendiceal torsion reported to literature.
Torsion of the vermiform appendix is a rare disorder, which causes abdominal symptoms indistinguishable from acute appendicitis. Primary and secondary torsion are recognized in the appendiceal torsion. In primary torsion, specimen examination shows secondary ischemic or necrotic change and luminal dilatation distal to the torsion site without any primary lesion. About 25 cases of primary torsion have been reported to date. Secondary torsion is much rarer and only 7 cases have been reported to date. Secondary torsion is caused by appendiceal abnormality, which includes cystadenoma, mucocele, fecalith impaction, and malformation [1–11]. Preoperative diagnosis of torsion of the appendix is sometimes difficult. Here, we report a case of appendiceal torsion with fecalith. This case (a 76-year-old male) is the oldest one among the patients with appendiceal torsion reported to date.
In 1918, Payne et al  reported the first case of torsion of the appendix. Torsion of the appendix may occur at any age (range 3–60 years). No case of more than 60 years old has been reported. Our case was 76 years old, and, thus, was the oldest one among the patients with appendiceal torsion reported to date  Primary torsion appears to be often associated with long appendix. The appendix averages 6.5 cm (ranging from 1 to 20 cm) in length. Secondary torsion has been reported to be associated with cystadenoma, mucocele, fecalith impaction, and malformation of the appendix. The presence of fecalith has been also reported to be closely associated with acute appendicitis . Torsion of the appendix observed in this case may be, at least in part, caused by the presence of fecalith, because no other primary lesions and malformation were detected. The preoperative diagnosis of appendiceal torsion is sometimes difficult. Abdominal computed tomography (CT) examination with the contrast medium has been shown to be helpful for the preoperative diagnosis of appendiceal torsion 
Torsion of the vermiform appendix is a rare disorder, which causes abdominal symptoms indistinguishable from acute appendicitis. Our case (a 76 year-old male) was the oldest one among the patients with appendiceal torsion reported to date. In this case, the presence of fecalith may be associated with torsion of the appendix.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal
- Kitagawa M, Kotani T, Yamano T, Tsurudome H, Hatakeyama T, Kuriu Y, Nishi H, Yabe M: Secondary torsion of vermiform appendix with mucinous cystadenoma. Case Rep Gastroenterol. 2007, 1: 32-37. 10.1159/000104679.PubMed CentralView ArticlePubMedGoogle Scholar
- Bestman TJR, van Cleemput M, Detournary G: Torsion of the vermiform appendix: a case report. Acta Chir Belg. 2006, 106: 208-229.Google Scholar
- Sarin YK, Pathak D: Torsion of vermiform appendix. Ind Pediatr. 2006, 43: 266-267.Google Scholar
- Val-Bernal JF, Gonzalez-Vela C, Garijo MF: Primary acute torsion of the vermiform appendix. Pediatr Pathol Lab Med. 1996, 16: 655-661. 10.1080/107710496175589.View ArticlePubMedGoogle Scholar
- Tzilinis A, Vahedi MH, Wittenborn WS: Appendiceal torsion in an adult: case report and review of the literature. Curr Surg. 2002, 59: 410-411. 10.1016/S0149-7944(02)00615-3.View ArticlePubMedGoogle Scholar
- Merrett ND, Lubowski DZ, King DW: Torsion of the vermiform appendix: a case report and review of literature. Aust N Z J Surg. 1992, 62: 981-983. 10.1111/j.1445-2197.1992.tb07661.x.View ArticlePubMedGoogle Scholar
- Bernal JF, Gonzalz-Vela C, Garijo MF: Primary acute torsion of the appendix. Ped Pathol Lab Med. 1996, 4: 655-662. 10.1080/107710496175589.Google Scholar
- Dewan PA, Woodward A: Torsion of the vermiform appendix. J Pediatr Surg. 1986, 21: 379-380. 10.1016/S0022-3468(86)80211-1.View ArticlePubMedGoogle Scholar
- Glichrist BF: Torsion of the appendix. J Pediatr Surg. 1995, 30: 901-902. 10.1016/0022-3468(95)90781-5.View ArticleGoogle Scholar
- Beevors EC: Torsion of the appendix. Lancet. 1920, 1: 597-598. 10.1016/S0140-6736(01)16632-8.View ArticleGoogle Scholar
- Gopal K, Kumar S, Grewal H: Torsion of the vermiform appendix. J Pediatr Surg. 2005, 40: 446-447. 10.1016/j.jpedsurg.2004.10.027.View ArticlePubMedGoogle Scholar
- Payne LE: A case of torsion of the appendix. Br J Surg. 1918, 6: 327-10.1002/bjs.1800062216.View ArticleGoogle Scholar
- Pinto Leite N, Pereira JM, Cunha R, Pinto P, Sirlin C: CT evaluation of appendicitis and its complications: imaging techniques and key diagnostic findings. AJR Am J Roentgenol. 2005, 185 (2): 406-417.View ArticlePubMedGoogle Scholar
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