AB050. SOH25_AB_032. An unusual presentation of intestinal malrotation with paraumbilical hernia and appendix as content

Background: Intestinal malrotation is a rare congenital condition due to incomplete rotation of the mesentery, often asymptomatic in adults. This case highlights an unusual presentation of malrotation in a 51-year-old woman with acute abdominal pain, central lump, and paraumbilical hernia containing the appendix.

Methods: Computed tomography (CT) imaging identified a paraumbilical hernia containing small bowel loops and indicated non-rotation subtype malrotation, with the duodenojejunal flexure in the midline, small intestine to the right, and large intestine on the left side of the abdomen. During surgery, an unexpected finding revealed the appendix and its mesentery as the sole contents of the hernia sac, with the cecum located centrally. An appendectomy was performed, and the hernia was repaired.

Results: Postoperative recovery was uneventful, with the patient remaining stable and discharged after two days. Histopathological analysis of the appendix showed no inflammation. At a three-month outpatient review, the wound had healed well with no hernia recurrence.

Conclusions: This case is noteworthy for the unusual positioning of the appendix within a paraumbilical hernia, an unexpected manifestation of intestinal malrotation. It underscores the importance of considering anatomical variations in surgical diagnoses and interventions.

Keywords: Intestinal malrotation; paraumbilical hernia; appendix; appendicectomy; congenital anomaly