Salim Khattak, Arshad Ali.
Torsion of Appendix - case report.
J Postgrad Med Inst Jan ;17(2):276-8.

A young man, aged 35 years, was admitted with chief complaints of pain abdomen. Pain started abruptly, one day ago, slightly increased with passage of time. He was then rushed to A&E Department early in the morning where after initial treatment, he was shifted to our unit. On arrival, patient had pain right iliacfossa and right hypochondrium, he was anorexic, vomited once, feeling nauseating. Patient bladder and bowls functions were normal. On examination, patient was tender in right iliac fossa with positive rebound tenderness and palpable mass in right iliac fossa? Rest of abdomen was slightly tender with no distention and bowel sounds audible, patient was stable haemodynamically. On laboratory investigations, patient`s total leukocytic count was increased to 14500 with differential leukocytic count showing neutrophilic predominance indicating acute inflammatory disease. Ultrasound showed soft tissue mass in the right iliac fossa with rest of abdomen normal. After careful preparation of the patient for surgery and taking informed consent, patient was shifted to operation theatre for operation the very same afternoon. Abdomen was opened through grid iron incision, mass showed on ultrasound was actually grossly swollen appendix due to obstruction, cause of obstruction being twist in its base along with its mesentery. Mesentery was untwisted in the clockwise direction and appendectomy performed in usual way by burring base of appendix with the help of purse string suture in the cecal wall.

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