Unusual position of appendix in a complicated group of children with acute appendicitis causing midline with additional right lower quadrant incision: A report of 2 cases

Abstract

We reported two cases of acute appendicitis in a complicated group of pediatric patients in which the appendix also located at extraordinary sites. A child aged 5 years old experienced abdominal tenderness with the greatest point at lower abdomen. Another child aged 13 years old suffered from symptoms of abdominal pain. Due to the very young age and presence of full bladder in the former and the underlying cerebral palsy with spasticity in nature in the latter case, finally the diagnosis of appendicitis was established with a great concern. Open appendectomies through Lanz incision were performed in both cases. Since one’s appendix positioned at left-upper quadrant secondary to midgut malrotation and another one’s found at mid-abdomen because of malposition of the gut following a previous transumbilical surgery for gastroschisis at birth, extra midline incisions were indispensable for both patients. Communication barriers presented in a very young aged patient and a patient with cerebral palsy precluded an accuracy of initial history taking and physical examination to establish definite diagnosis. As a result, in some cases, the anatomical location of the appendix may not be at the McBurney point and an additional surgical approach is necessary.