Synchronous appendicitis and cholecystitis in the setting of intestinal malrotation: A rare presentation of adhesion of the appendix to the gallbladder

Intestinal malrotation is a congenital abnormality that can complicate diagnosis of abdominal conditions. We present the first documented case of concurrent acute appendicitis, acute cholecystitis, and congenital intestinal malrotation. A 58-year-old female initially presented with perforated cholecystitis complicated by abscess formation and cholangitis, requiring interventional drainage and endoscopic stenting. Five months later, she returned with concurrent acute cholecystitis and appendicitis. Due to intestinal malrotation, the appendix was located in the right upper quadrant adjacent to the gallbladder and had eroded into the anterior abdominal wall. Laparoscopic subtotal cholecystectomy and appendectomy were successfully performed with pathology confirming both diagnoses. This case demonstrates a need for heightened suspicion of atypical presentations in patients with anatomical variants. Anatomical proximity may predispose to concurrent disease through bacterial spread. This case reinforces the importance of maintaining broad differential diagnoses and utilizing comprehensive imaging in patients with anatomical variants.