24/07/2024
Left-sided appendicitis is a rare digestive system disease requiring emergency surgery, is classified according to congenital anatomical abnormalities, mainly situs inversus and intestinal malrotation, and accounts for approximately 93.6% of cases (2). Due to the abnormal anatomy of the left appendix, and many times without typical clinical manifestations, it is easy to misdiagnose. Once the diagnosis is delayed, it may lead to periappendiceal abscess or perforation, which may be life-threatening in severe cases.
Congenital abdominal heterotaxy, with the ascending colon located in the left abdomen and the descending and sigmoid colon located in the right abdomen, is often accompanied by heterotopia of other organs such as the heart and liver, and the cecum is also located in the left lower abdomen (3). However, this patient is different from the one with situs inversus, in the sense that the cecum and ascending colon are still on the left side of the abdominal cavity and the descending colon is also on the left side during embryonic development, when the small intestine is located on the right side of the right colon and the appendix is also far from the right lower quadrant (4).
The symptoms and signs of ectopic appendicitis can vary due to the variation of location, which often brings considerable difficulties to clinical diagnosis and treatment. Ectopic appendix in the left lower quadrant is rare, acute appendicitis is easily misdiagnosed as a sigmoid colon, and urinary system diseases and gynecological diseases occur in female patients (5). Therefore, doctors may misjudge the patient's condition, resulting in the loss of the best operation opportunity, which results in complications. When clinicians encounter patients with left lower abdominal pain during practice, they should think divergently to consider the possibility of this pain leading to disease, while excluding the possibility of other diseases, so as not to misdiagnose and mistreat.
To make a correct diagnosis of ectopic appendicitis at an early stage requires surgeons to have rich clinical experience and be familiar with the type and clinical characteristics of ectopic appendicitis. Physicians need to correctly understand the characteristics of severe abdominal pain in appendicitis and its diagnostic value in appendicitis. If necessary, severe pain, combined with imaging examinations and white blood cell count and C-reactive protein test results, to the exclusion of other diseases, can suggest the diagnosis and facilitate improvement in the correct diagnosis rate and reduce misdiagnosis (6). In particular, CT, abdominal ultrasonography, laparoscopy, and CRP are of great value in the diagnosis and differential diagnosis of acute appendicitis (7). Rao et al. retrospectively a**lyzed 209 cases of appendectomy and concluded that the coincidence rate between the results of abdominal CT examination and postoperative pathological diagnosis was as high as 93%, and for non-appendicitis patients with suspected appendicitis, the exclusion rate of abdominal CT was 99% (8). Detection of CRP in peripheral blood by Pruekprasert et al revealed its high sensitivity and accuracy for the diagnosis of acute appendicitis (9).
Once ectopic appendicitis is diagnosed, surgical treatment should be given actively, and for a small number of patients with suspected appendicitis, it is indeed difficult to confirm the diagnosis, and if available, laparoscopic exploration is feasible. Under the laparoscope, the abdominal cavity and pelvic cavity can be explored to determine the diagnosis of ectopic appendicitis and exclude acute abdomen caused by other diseases. Laparoscopic appendectomy can reduce the incidence of incision infection and abdominal abscess. It has the advantages of less trauma, faster postoperative recovery, and fewer complications (10). Therefore, it is a safe and effective method for the treatment of ectopic appendicitis. Successfully done appendectomy for this type in our hospital. Thank you
