A 43-year-old woman presented to the emergency room with hypogastric pain, fever and diarrhea for two days.
Physical examination revealed a temperature of 37.3 oC, 115 t/min, blood pressure 130 mmHg, hypogastric pain and signs of peritoneal irritation.
Analytical: leukocytes 18,000μ/l and fibrinogen 939.9 mg/dl.
Abdominal CT: the duodenum presents malrotation, making a draw around the mesenteric venous axis.
A collection is observed with gas and liquid bubbles that includes the small intestine in the proximity to the uterine fundus and vesicouterine recess, as well as inflamed appendix and involvement of the periaqueductal fat.
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The patient underwent surgery, finding the intestinal malrotation described with the duodenum on the right side and the cecum resting in the upper left quadrant of the abdomen.
The appendix is inflamed with an important associated pelvic abscess.
Pelvic abscess resection and drainage of small intestine loops were performed after Ladd's band section.
The patient recovered satisfactorily one week after admission with antibiotic treatment.
