A Unique Case of Appendiceal Intussusception (Inversion): A Case in Bloom
Stylianos Mantalovas,
Eleni Paschou,
Ismini Kountouri,
Christina Sevva,
Konstantinos Papadopoulos,
Panagiota Roulia,
Marios Dagher,
Styliani Laskou,
Vasileios Lagopoulos,
Charilaos Koulouris,
Fedra Louloudopoulou,
Periklis Kopsidas,
Konstantinos Sapalidis,
Isaak Kesisoglou,
Christoforos Kosmidis
Affiliations
Stylianos Mantalovas
Third Surgical Department, “AHEPA” University Hospital, Medical Faculty, Aristotle University of Thessaloniki, 1 Kiriakidi Street, 54636 Thessaloniki, Greece
Eleni Paschou
Third Surgical Department, “AHEPA” University Hospital, Medical Faculty, Aristotle University of Thessaloniki, 1 Kiriakidi Street, 54636 Thessaloniki, Greece
Ismini Kountouri
Third Surgical Department, “AHEPA” University Hospital, Medical Faculty, Aristotle University of Thessaloniki, 1 Kiriakidi Street, 54636 Thessaloniki, Greece
Christina Sevva
Third Surgical Department, “AHEPA” University Hospital, Medical Faculty, Aristotle University of Thessaloniki, 1 Kiriakidi Street, 54636 Thessaloniki, Greece
Konstantinos Papadopoulos
Third Surgical Department, “AHEPA” University Hospital, Medical Faculty, Aristotle University of Thessaloniki, 1 Kiriakidi Street, 54636 Thessaloniki, Greece
Panagiota Roulia
Third Surgical Department, “AHEPA” University Hospital, Medical Faculty, Aristotle University of Thessaloniki, 1 Kiriakidi Street, 54636 Thessaloniki, Greece
Marios Dagher
Third Surgical Department, “AHEPA” University Hospital, Medical Faculty, Aristotle University of Thessaloniki, 1 Kiriakidi Street, 54636 Thessaloniki, Greece
Styliani Laskou
Third Surgical Department, “AHEPA” University Hospital, Medical Faculty, Aristotle University of Thessaloniki, 1 Kiriakidi Street, 54636 Thessaloniki, Greece
Vasileios Lagopoulos
Third Surgical Department, “AHEPA” University Hospital, Medical Faculty, Aristotle University of Thessaloniki, 1 Kiriakidi Street, 54636 Thessaloniki, Greece
Charilaos Koulouris
Third Surgical Department, “AHEPA” University Hospital, Medical Faculty, Aristotle University of Thessaloniki, 1 Kiriakidi Street, 54636 Thessaloniki, Greece
Fedra Louloudopoulou
Third Surgical Department, “AHEPA” University Hospital, Medical Faculty, Aristotle University of Thessaloniki, 1 Kiriakidi Street, 54636 Thessaloniki, Greece
Periklis Kopsidas
Third Surgical Department, “AHEPA” University Hospital, Medical Faculty, Aristotle University of Thessaloniki, 1 Kiriakidi Street, 54636 Thessaloniki, Greece
Konstantinos Sapalidis
Third Surgical Department, “AHEPA” University Hospital, Medical Faculty, Aristotle University of Thessaloniki, 1 Kiriakidi Street, 54636 Thessaloniki, Greece
Isaak Kesisoglou
Third Surgical Department, “AHEPA” University Hospital, Medical Faculty, Aristotle University of Thessaloniki, 1 Kiriakidi Street, 54636 Thessaloniki, Greece
Christoforos Kosmidis
Third Surgical Department, “AHEPA” University Hospital, Medical Faculty, Aristotle University of Thessaloniki, 1 Kiriakidi Street, 54636 Thessaloniki, Greece
A 40-year-old female patient presented to a secondary facility with dull lower abdominal pain and a persistent low-grade fever. Her laboratory results showed elevated inflammation markers. A CT scan revealed two abscesses in the lesser pelvic region in direct contact with the apex of the appendix, the posterior wall of the uterus, and the right-side appendages. The patient responded well to intravenous antibiotics, and an MRI scan revealed the cause to be an appendiceal rupture. The patient was scheduled for an appendectomy. The procedure started laparoscopically but had to be converted to an open one with a midline infra-umbilical incision in order to protect the right appendages. A standard appendectomy was conducted, and the histology report revealed rupture of the appendix with concomitant wall inversion in the context of fibrous adhesions as well as obstruction due to a fecalith. Patient recovery and follow-up were excellent. Acute appendicitis, while frequently encountered in surgical practice, can present a diagnostic conundrum when it manifests in an atypical manner. This unique form of inversion appeared to confer a protective role against peritonitis, primarily through the mechanism of obstruction occurring centrally to the rupture. We suggest that this case should be included in current classifications as a partial inversion of the appendix after rupture and inflammation.
