A Case Report: An Atypical 22-Cm-Long Appendix

Abstract

Introducrion;

The appendix is a midgut organ, a small outpouching of the cecum, with variable sizes and anatomical locations. Its inflammation is the most common appendix disease, leading to appendectomy, the most common emergency surgery worldwide.                                              

Case presentation:

Upon arrival at the emergency department, a 30-year-old male reported experiencing abdominal pain for the past three days. The pain started at the periumbilical area and shifted to the right lower quadrant. Laboratory findings showed leukocytosis (11,000 microliters). Non-enhanced computed tomography showed an enlarged thickened appendix measuring 1.1 cm with associated multiple enlarged regional lymph nodes. We started the needed medications, including antibiotics, and shifted the patient to the operating room. We began a laparoscopic approach but could not visualize the appendix, so we switched to an open approach. We found a very long subserosal and retro-cecal inflamed appendix.                                                                                                                  

Conclusion:

Long acute appendicitis is unusual, and the surgeon must consider all anatomical variations. Along with the history and examination, laboratory investigation and diagnostic images help the surgeon reach the correct diagnosis with early surgical intervention and avoid possible complications.