CT Classification Improved Precision of Left Appendicitis Diagnosis with Intestine Malrotation

Abstract

Complicated left appendicitis is a rare condition in the left lower abdomen that can lead to serious complications like peritonitis and abscesses. Computed Tomography classification can improve anatomical detail and assist in surgical planning. This presentation reviews two cases of delayed diagnosis in patients with intestinal malrotation. Both patients had recurring lower left abdominal pain. The first exhibited localized tenderness, while the second had diffuse tenderness. Both showed leukocytosis and elevated neutrophil levels. A non-contrast CT for the first confirmed suppurative-phlegmonous acute appendicitis with a periappendiceal abscess, while the second CT revealed perforating acute appendicitis with ulcerative mucosa. The CT classification shows that both patients had intestine malrotation with DNJRCL and DYJRCL subtypes according to CT classification. Fortunately, both patients recovered after undergoing appendectomies. CT classification can improve awareness of anatomical variants, which is vital for accurately diagnosing left-sided appendicitis.