# A Unique Case of Appendiceal Intussusception (Inversion): A Case in Bloom

## TL;DR

A 40-year-old woman with appendiceal rupture and inversion showed a protective effect against peritonitis, suggesting a new classification for this rare condition.

## Contribution

The paper introduces a unique case of appendiceal inversion post-rupture that may protect against peritonitis.

## Key findings

- The patient's appendiceal rupture was accompanied by wall inversion and fibrous adhesions.
- The inversion mechanism may have obstructed the rupture, preventing peritonitis.
- The case suggests a new classification for partial appendiceal inversion after rupture.

## Abstract

A 40-year-old female patient presented to a secondary facility with dull lower abdominal pain and a persistent low-grade fever. Her laboratory results showed elevated inflammation markers. A CT scan revealed two abscesses in the lesser pelvic region in direct contact with the apex of the appendix, the posterior wall of the uterus, and the right-side appendages. The patient responded well to intravenous antibiotics, and an MRI scan revealed the cause to be an appendiceal rupture. The patient was scheduled for an appendectomy. The procedure started laparoscopically but had to be converted to an open one with a midline infra-umbilical incision in order to protect the right appendages. A standard appendectomy was conducted, and the histology report revealed rupture of the appendix with concomitant wall inversion in the context of fibrous adhesions as well as obstruction due to a fecalith. Patient recovery and follow-up were excellent. Acute appendicitis, while frequently encountered in surgical practice, can present a diagnostic conundrum when it manifests in an atypical manner. This unique form of inversion appeared to confer a protective role against peritonitis, primarily through the mechanism of obstruction occurring centrally to the rupture. We suggest that this case should be included in current classifications as a partial inversion of the appendix after rupture and inflammation.