APENDICITIS AGUDA IZQUIERDA; UNA PRESENTACIÓN POCO HABITUAL DE UNA PATOLOGÍA MUY COMÚN EN LA POBLACIÓN ECUATORIANA. REVISIÓN BIBLIOGRÁFICA Y REPORTE DE UN CASO.

Abstract

Introduction Acute appendicitis is one of the most common urgent surgical pathologies in the Ecuadorian population, and the atypical presentation of the appendix on the left side is presented as a diagnostic challenge, since it is observed more frequently in congenital anomalies such as malrotation of the midgut, a rare disorder with an incidence of one in 10,000 individuals. Case description We present the clinical case of an 8-year-old girl with no significant pathological history, admitted to the Pediatrics service with a 48-hour history of abdominal pain located in the left hemiabdomen, accompanied by nausea, vomiting, abdominal distention and thermal rise; tender abdomen on palpation in the flank and left iliac fossa, positive Mussy's sign. The patient presented with leukocytosis and neutrophilia; imaging examinations revealed thickening of the mesenteric fat at the level of the left iliac fossa and air-fluid levels at an elevation of the colonic framework. She underwent surgery and the findings were an appendicular plastron made up of a perforated appendix in the distal third and undamaged appendicular base, omentum and distal third of the descending colon; her postsurgical evolution was favorable. Conclusion Acute appendicitis can present with atypical symptoms due to unusual locations of the appendix, one of the unusual presentations can present in malrotation. Most cases are asymptomatic until the development of acute complications and require imaging for diagnosis, becoming a challenge when defining the appropriate and timely treatment.