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      Appendicite aigue à manifestation clinique gauche sur mésentère commun complet: à propos d’un cas Translated title: Acute appendicitis with left clinical manifestation on complete common mesentery: about one case

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          Abstract

          Abstract

          La malrotaion intestinale chez l’enfant est une anomalie rare due à un arrêt des phénomènes de rotation et d’accolement de l’intestin primitif. Elle peut être grave en cas de mésentère commun incomplet en se compliquant d’un volvulus du grêle ou asymptomatique si la rotation s’arrête à 90° se déclarant ainsi par des formes atypiques d’appendicite comme c’est le cas de notre observation. Il s’agit d’un garçon de 15 ans qui a présenté une semaine avant son admission des douleurs abdominales diffuses avec vomissements alimentaires évoluant dans un contexte fébrile et chez qui l’examen clinique avait montré une sensibilité de la fosse iliaque gauche. Le bilan biologique avait objectivé un syndrome inflammatoire biologique. Les examens radiologiques étaient en faveur d’un mésentère commun complet avec multiples adénopathies mésentériques et infiltration de la graisse mésentérique. L’exploration cœlioscopique a confirmé le diagnostic de malrotation avec appendicite aigue. L’évolution après l’appendicectomie était favorable. Si l’appendicite aigue dans sa forme habituelle est une urgence chirurgicale fréquente chez l’enfant, ses formes atypiques dans le cadre d’une malrotation intestinale ou d’un situs inversus restent très difficiles à diagnostiquer. L’imagerie moderne notamment la tomodensitométrie (TDM) abdominale puis la cœlio-chirurgie ont beaucoup contribué au diagnostic de ces forms.

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          Most cited references14

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          Left-sided acute appendicitis with situs inversus totalis: review of 63 published cases and report of two cases.

          Situs inversus (SI) and midgut malrotation (MM) are uncommon anatomic anomalies that complicate diagnosis and management of acute abdominal pain. We present two cases of left-sided acute appendicitis with situs inversus totalis and a literature review of studies published in English language on left-sided acute appendicitis, accessed via Pubmed and Google Scholar database. Sixty-three published cases of left-sided acute appendicitis were evaluated, and two patients (M:16 yr, F:17 yr) who presented to our clinic with left lower quadrant pain caused by left-sided acute appendicitis were reported. Thirty-five of the patients were male and 30 were female (including our patients) with age range from 8 to 63 years and median age of 26.7 +/- 14.0 years. Fifty-three patients had situs inversus totalis (SIT), 8 had MM and two were with malrotation of the caecum. Thirty-eight patients had applied to the hospital with left lower quadrant pain, 12 with right and 6 with bilateral lower quadrant pain. Thirty patients were diagnosed as having SIT or MM, while the diagnosis in 12 patients was established during the intraoperative period. Eleven patients with SIT were aware of having this anomaly. Five of the patients underwent laparoscopic appendectomy and in two patients laparoscopic appendectomy and cholecystectomy were performed in one session. Preoperative diagnosis has been easier to achieve after 1985, when ultrasonography (USG) and computed tomography (CT) were introduced into the medical practice. SIT and MM should be taken into consideration in patients with findings of the physical examination suspicious for left-sided acute appendicitis. X-ray, USG, CT and diagnostic laparoscopy are beneficial in developing the differential diagnosis.
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            Left lower quadrant pain of unusual cause.

            The differential diagnosis of left lower quadrant abdominal pain in an adult man includes, among others, sigmoid diverticulitis; leaking abdominal aortic aneurysm; renal colic; epididymitis; incarcerated hernia; bowel obstruction; regional enteritis; psoas abscess; and in this rare instance, situs inversus with acute appendicitis. We report a case of situs inversus totalis with left-sided appendicitis and a brief review of the literature. There were several subtle indicators of total situs inversus present that were missed by the physicians and surgeons who initially evaluated the patient prior to surgery. Computed tomography scan with contrast, however, revealed the diagnosis immediately, and treatment was successfully initiated.
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              Malrotation of the intestines in children: the effect of age on presentation and therapy.

              Because of the devastating consequences of midgut volvulus as a result of malrotation, we reviewed the charts of 70 consecutive children to define the spectrum of presentation. Although 27 patients (39%) had presenting symptoms within the first ten days of life, 35 (50%) were older than 2 months of age. In general, the older children had a longer course of vague, antecedent symptoms such as intermittent, nonbilious vomiting and chronic abdominal pain. Associated congenital anomalies were common, with 32 patients (46%) presenting with 56 anomalies, the most prevalent of which were intestinal atresia, imperforate anus, duodenal web, and cardiac and orthopedic anomalies. Upper gastrointestinal (GI) series revealed the diagnosis in 29 cases (41%), as did contrast enema in 24 (34%). It is important to note that volvulus, intestinal gangrene, and mortality occurred regardless of age or chronicity of symptoms. Fifteen patients (21%) were discovered serendipitously while being evaluated and treated for seemingly unrelated conditions. No morbidity of mortality occurred in those patients who underwent subsequent semielective Ladd's procedure. The majority of morbidity and all seven mortalities occurred in patients with volvulus and intestinal necrosis. This study emphasizes the need for consideration of Ladd's procedure for children of all ages. In addition, due to the broad range of initial symptoms, a high index of suspicion is required in evaluating children with possible malrotation. Because it remains impossible to predict which patients will have catastrophic complications (based on age or type of presentation), we urge that even incidentally discovered patients with intestinal malrotation undergo Ladd's procedure.
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                Author and article information

                Journal
                Pan Afr Med J
                pamj
                The Pan African Medical Journal
                African Field Epidemiology Network
                1937-8688
                1937-8688
                2010
                18 November 2010
                : 7
                : 13
                Affiliations
                [1 ]Service de chirurgie pédiatrique, CHU Hassan II de Fès, Fès, Maroc
                Author notes
                [& ]Corresponding author: Aziz Elmadil, Service de chirurgie pédiatrique I, CHU Hassan II, Fès 30000, Tel: 00212661584394, Maroc
                Article
                3172621
                21918700
                0facb48c-5b47-4060-b2fd-0075b29b9c59
                Copyright © Aziz Elmadil et al.

                The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 21 October 2010
                : 18 November 2010
                Categories
                Life Sciences
                Medicine

                Medicine
                malrotation intestinale,appendicite,fosse iliaque gauche
                Medicine
                malrotation intestinale, appendicite, fosse iliaque gauche

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