case_images: PMC8335754_01
case_images: (a-c) (cephalad to caudad): A 12-year-old boy presented with abdominal distension, vomiting and a raised white cell count. Axial CT revealed the abnormal caecal position (blue star) in the left lower quadrant with an anterior cephalad thickened appendix containing an appendicolith (arrow) and adjacent fat stranding.
case_images: SAJR-25-2153-g001.jpg
case_images: PMC8335754_01_SAJR-25-2153-g001.jpg
case_images: F0001
case_images: The caecum was left sided (Figure 1a-c) with a 50 mm diameter collection in the left iliac fossa associated with a 7-mm long dense sausage-shaped structure, presumed to be the appendix with an appendicolith (Figure 2a and b).
case_images: (a and b) Axial and coronal CT images demonstrating appendiceal wall thickening and enhancement with a faecolith (blue arrows) anterior and cephalad to the caecum (star). The right iliac fossa was unremarkable with fluid in the paracolic gutter (red arrow). Note the liver (red circle) is in the normal anatomic position.
case_images: SAJR-25-2153-g002.jpg
case_images: PMC8335754_01_SAJR-25-2153-g002.jpg
case_images: F0002
case_images: The caecum was left sided (Figure 1a-c) with a 50 mm diameter collection in the left iliac fossa associated with a 7-mm long dense sausage-shaped structure, presumed to be the appendix with an appendicolith (Figure 2a and b).
case_images: Coronal reconstructed maximum intensity projection image demonstrating the superior mesenteric artery (blue arrow) and its branches including the ileocolic (black arrow) from which the appendicular artery arises. The vessels are seen coursing to the left, corresponding to the position of the caecum and appendicolith. This is in contrast to the normal course towards the right lower quadrant.
case_images: SAJR-25-2153-g003.jpg
case_images: PMC8335754_01_SAJR-25-2153-g003.jpg
case_images: F0003
case_images: The distal SMA was seen coursing towards the left in the region where the high-density sausage-shaped structure was seen (Figure 3).