Clinical analysis of left-sided appendicitis: report of 2 cases and review of 212 published cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LUO Yun ¹ , WU Dingquan ¹ , ZHU Changkang ¹ ,  WANG Chongshu ^2,3

1. The First Department of General Surgery, Beibei Traditional Chinese Medical Hospital of Chongqing, Chongqing 400700, P. R. China;
2. Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;
3. Department of General Surgery, Nanchong Oriental Hospital, Nanchong, Sichuan 637000, P. R. China;

Corresponding?author：

WANG Chongshu, Email: chongshu-wang@163.com

Keywords：

left-sided appendicitis; situs inversus totalis; midgut malrotation; cecal malrotation; literature review

DOI：

10.7507/1007-9424.201710066

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Objective To investigate the clinical features, diagnosis, and surgical methods of left-sided appendicitis (LSA). Methods We retrieved LSA-related literatures through Pubmed, Google Scholar English databases, Wanfang, CNKI, VIP, and SinoMed databases (published from January 1981 to June 2017), as well as 2 cases of LSA who treated in Beibei Traditional Chinese Medical Hospital, to analyze the clinical characteristics of LSA and its diagnosis and treatment methods. Results There were 92 articles in a total of 212 LSA patients were retrieved, and 2 cases treated in Beibei Traditional Chinese Medical Hospital, a total of 214 LSA patients were included in the analysis. Pain fixed position of LSA: 139 cases (65.0%) located in left-lower quadrant, 30 cases (14.0%) located in right-lower quadrant, 8 cases (3.7%) located in peri-umbilical, 15 cases (7.0%) located in mid-lower abdomen, 15 cases (7.0%) located in left-upper quadrant, 3 cases (1.4%) located in right-upper abdomen, 2 cases (0.9%) located in mid-upper abdomen, 2 cases (0.9%) located in pelvic cavity, respectively. LSA had occurred in association with several types of abnormal anomalies: 131 cases (61.2%) suffered from situs inversus totalis (SIT), 53 cases (24.8%) suffered from midgut malrotation (MM), 21 cases (9.8%) suffered from cecal malrotation, 4 cases (1.9%) suffered from long appendix, 2 cases (0.9%) suffered from free ascending colon, and 3 cases (1.4%) were unclear. The diagnosis of 114 LSA cases (53.3%) before operation was correct, in which the correct diagnosis rates of SIT-LSA and MM-LSA were 74.8% (98/131) and 22.6% (12/53), respectively. Three patients (1.4%) underwent conservative treatment, and 211 patients (98.6%) underwent surgical treatment, including 25 cases (11.7%) of laparoscopic surgery, 145 cases (67.8%) of open abdominal surgery, and unknown of 41 cases (19.1%). Laparotomy incision: abdominal incision in 74 cases (51.0%), ventral midline incision in 16 cases (11.0%), the left side of the anti McBurney incision in 43 cases (29.7%), right McBurney incision in 12 cases (8.3%). Conclusions LSA mainly occurs in association with 2 types of congenital anomalies: SIT and MM. There is some difficult to make diagnosis for abnormal anatomy and inaccurate pain location of LSA, so it is easy to cause the delay in diagnosis or misdiagnosis. For LSA, the choices of laparoscopy or laparotomy operation methods are applicable.

Citation： LUO Yun, WU Dingquan, ZHU Changkang, WANG Chongshu. Clinical analysis of left-sided appendicitis: report of 2 cases and review of 212 published cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(5): 572-577. doi: 10.7507/1007-9424.201710066 Copy

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1. Akbulut S, Ulku A, Senol A, et al. Left-sided appendicitis: review of 95 published cases and a case report. World J Gastroenterol, 2010, 16(44): 5598-5602.
2. Naik MB, Rao KS. Laparoscopic appendicectomy in situs inversus totalis. J Evolut Med Dent Sci, 2015, 4(29): 5064-5067.
3. Akbulut S, Caliskan A, Ekin A, et al. Left-sided acute appendicitis with situs inversus totalis: review of 63 published cases and report of two cases. J Gastrointest Surg, 2010, 14(9): 1422-1428.
4. 趙玉生, 候武衛. 以左下腹疼痛為表現的闌尾炎 8 例報告. 中國罕少疾病雜志, 1999, 6(3): 21-21.
5. Tawk CM, Zgheib RR, Mehanna S. Unusual case of acute appendicitis with left upper quadrant abdominal pain. Int J Surg Case Rep, 2012, 3(8): 399-401.
6. Odabasi M, Arslan C, Abuoglu H, et al. An unusual presentation of perforated appendicitis in epigastric region. Int J Surg Case Rep, 2014, 5(2): 76-78.
7. Shekhar A, Hendahewa R, Premaratne G. A diagnostic dilemma: left-sided appendicitis in a 10 year old boy with previously undiagnosed intestinal malrotation. A case report. Int J Surg Case Rep, 2015, 14: 10-12.
8. Kieffer W. Migratory abdominal pain. J Surg Case Rep, 2010, 2010(8): 7.
9. Akram H, Siddiqui ZR. Appendicitis in a malrotated gut: an unusual cause of left upper quadrant abdominal pain. J Coll Physicians Surg Pak, 2013, 23(9): 665-666.
10. Gotecha S, Bharadwaj RN, Dhaigude B, et al. Left sided perforated appendicitis in an adult with malrotated gut. Pak J Surg, 2012, 28(3): 239-240.
11. Kara T, Durmaz S. Computed tomography findings of left-sided acute appendicitis with midgut malrotation. CausaPedia, 2014, 3(293): 1-5.
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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical analysis of left-sided appendicitis: report of 2 cases and review of 212 published cases

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