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Amir Hussain.; Sch J Med Case Rep 2014; 2(7):502-503.
Scholars Journal of Medical Case Reports
ISSN 2347-6559 (Online)
ISSN 2347-9507 (Print)
Sch J Med Case Rep 2014; 2(7):502-503
©Scholars Academic and Scientific Publishers (SAS Publishers)
(An International Publisher for Academic and Scientific Resources)
Acute Torsion of Vermiform Appendix: A Rare Cause of Acute Abdomen
Amir Hussain
RKM Hospital,Calcutta, West Bengal, India
*Corresponding Author:
Name: Amir Hussain
Abstract: Acute torsion of vermiform appendix is a rare, where appendix twists at its own axis. Hereby case report of
primary acute torsion of vermiform appendix in a 2 year old boy who presented with clinical signs of acute appendicitis
has been reported.
Keywords: Appendix, Torsion, acute abdomen, Appendicitis
Torsion of vermiform appendix is rare and is
clinically indistinguishable from acute appendicitis. I
present a case report of primary acute torsion of
vermiform appendix in a 2 year old boy who presented
with clinical signs of acute appendicitis.I believe that to
the best of our knowledge, this is the youngest patient
ever reported with primary acute torsion of vermiform
A 2 year old boy was admitted to the hospital
with 2 day history of right sided abdominal pain
associated with multiple episodes of vomiting. On
examination, he was pyrexial with atemperature of 37.8
C. Abdominal examination showed tenderness in right
iliac fossa with guarding. Blood white cell count was
20.0 x 109/ L with neutrophil count of 15.9 x 109 / L. CReactive protein was 21 mg/ L.Examination under
amaesthesia showed a mass in right iliac fossa and
laparotomy was performed through a McBurney’s
incision for possible acute appendicitis. A sub-caecal
appendix that had twisted on its long axis, at its base,
more than 270 degree in an anticlockwise direction.
Appendix was 8 cm in length and was distended,
congested and deep purple in colour with gangrenous
changes. There was no pus in the peritoneal cavity.
Postoperative period was uneventful. Histological
examination of the specimen showed an infarcted
congested appendix with an acute transmural
Acute torsion of vermiform appendix is a rare
cause of acute abdomen , where appendix twists at its
own axis. There are 21 reported cases of torsion of
vermiform appendix in English language literature,
which include 13 paediatric cases [1, 5, 16].
Available Online:
Collins [2], in his analysis of 71000 appendix
specimens, summarizing 40 years study, did not
describe any case of torsion. Chang [3] in 1983 reported
an incidence of two in 3003 appendectomies, and Lee
[4] found an incidence of 3 in 1869 appendectomies.
There are several common features in reports
of torsion [1, 5]. In most reports length of appendix is
greater than 7 cm. Position of appendix is variable. The
site of torsion occur most frequently 1 cm or more from
the base and less often at the base of appendix, with
clear demarcation between normal and abnormal
appendix. The direction of rotation is also variable,
more frequently anticlockwise than clockwise. The
degree of rotation varies from 270 to 1080 degree. In
children mean age is 9.1 years, the range 3-16 years.
The aetiology of the condition is uncertain.
The histological findings noted the presence of acute
inflammatory cells, congestion and haemorrhagic
infarction [6-8]. Payne [9] originally postulated that a
faecolith act as a point around which an irregularly
contracting appendix might pivot. Mcfadden [10] and
others [6, 11-13] also supported Payne’s original
concept of torsion occurring as the primary event.
Beevor’s [14], however hypothesised that inflammation
of the appendix causing distension of the distal
appendix as a primary event rendering it unstable and
thus more likely to twist.
Torsion can be a cause of auto-amputation of
the appendix and therefore an explanation for the
apparent congenital absence or agenesis of appendix
[1]. Thus before making a diagnosis of congenital
absence of appendix one should look for separate
mummified appendix.
Amir Hussain.; Sch J Med Case Rep 2014; 2(7):502-503.
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Available Online: