Abstract
A 40-year-old male who presented with non-reducible ventral abdominal mass that was tender to palpation on physical examination. He was found to have appendiceal incarceration within an epigastric ventral hernia defect secondary to congenital malrotation of the bowel, as initially identified on computed tomography. The patient was taken to the operating room emergently, where reduction of the hernia sac, appendectomy, and proper rotation of the colon was performed.
Highlights
A male patient with previously undiagnosed intestinal malrotation presented with symptomatic appendiceal incarceration within an epigastric hernia
Rapid growth of the small bowel around week 6 of gestation results in physiologic herniation of the gut through the umbilical ring; the small bowel rotates a full 270 degrees in a counter-clockwise direction to arrive at its normal anatomic position within the peritoneal cavity
A 40-year-old gentleman with a history of an epigastric hernia presented with two days of abdominal pain, discomfort, and a palpable lump in the anterior abdominal wall; his primary care doctor had promptly sent him to the Emergency Room after a brief office evaluation
Summary
Intestinal malrotation, though typically a disease of the neonatal and pediatric population can present in a variety of ways and throughout one’s lifespan. Management is dependent upon clinical presentation and acuity, though it is still unclear what role prophylactic intervention may play. We present a rare instance of appendiceal incarceration within an epigastric hernia, one of the many possible consequences associated with congenitally malrotated gut. Adults presenting with sequelae of intestinal malrotation should undergo surgical management for acute issues, though it is unclear whether or not these patients would benefit from pre-emptive intervention in the setting of congenital malrotation. Co-existing conditions such as ventral hernias should be managed . The authors declare no conflict of interest.
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