# Epigastric Pain Caused by Left Upper Quadrant Acute Appendicitis in the Setting of Undiagnosed Intestinal Malrotation

## TL;DR

A man in his 40s with epigastric pain was found to have acute appendicitis in an unusual location due to undiagnosed intestinal malrotation.

## Contribution

This case highlights the atypical presentation of appendicitis due to intestinal malrotation and the importance of early CT imaging.

## Key findings

- Acute appendicitis was found in the left upper quadrant due to undiagnosed intestinal malrotation.
- Early CT imaging was critical in identifying the atypical location of the appendicitis.
- The patient recovered fully after laparoscopic appendectomy and treatment for septic shock.

## Abstract

Acute appendicitis is a common surgical emergency that may present atypically due to anatomical variations. We report a case of a previously healthy male in his forties presenting with epigastric abdominal pain, vomiting, and fever, initially managed as gastritis. Contrast-enhanced computed tomography (CT) of the abdomen revealed acute appendicitis in the left upper quadrant on a background of previously undiagnosed intestinal malrotation. The patient underwent emergency laparoscopic appendectomy, with intensive perioperative care for septic shock. He ultimately made a full recovery. This case highlights the importance of maintaining a high index of suspicion for acute appendicitis in adults presenting with epigastric pain and illustrates the role of early CT in identifying atypical presentations caused by underlying anatomical variants.