Left-Sided Acute Appendicitis in an Adult With Intestinal Malrotation: A Case Report From Jordan

Intestinal malrotation persisting into adulthood is rare and may cause atypical presentations of common surgical emergencies such as appendicitis. Left-sided acute appendicitis due to malrotation is an uncommon but important diagnostic pitfall. We present A 28-year-old woman with no past medical history who presented to the emergency department at our institution in August 2025 with a three-day history of progressive left-sided abdominal pain localized mainly to the left iliac fossa. Laboratory investigations revealed leukocytosis (WBC 15 × 10⁹/L) with neutrophilia. Contrast-enhanced CT demonstrated intestinal malrotation with a reversed superior mesenteric artery/superior mesenteric vein relationship, large bowel predominantly on the left side, and a left-sided, inflamed appendix with minimal surrounding fat stranding, minimal pelvic free fluid, and small ovarian cysts. The solid abdominal organs were unremarkable. Laparoscopic exploration revealed an inflamed appendix in the left iliac fossa with a healthy cecum and bowel base. Laparoscopic appendectomy was performed without performing the Ladd's procedure. The postoperative course was uneventful, and histopathology confirmed acute appendicitis with focal serositis. Intestinal malrotation in adults can shift the appendix to the left hemipelvis, leading to left-sided abdominal pain and diagnostic delay. Recognition of imaging features is crucial for diagnosis and surgical planning. Laparoscopic appendectomy provides safe and effective management.