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LCDR David E. Smith, MC, USN; LCDR James M. Jacquet, MC, USN; CDR Richard W. Virgilio, MC, USN

AMA Arch Surg. 1974;109(3):443-447.

Abstract
A patient with left upper quadrant appendicitis correctly diagnosed preoperatively is presented and the four cases previously reported are reviewed. The rarity of left-sided appendicitis coupled with the frequent referral of pain to the contralateral side often leads to an erroneous diagnosis. The physical examination is of limited value unless dextrocardia is noted. This case demonstrates the value and safety of a preoperative barium enema in localization of the appendix. The intraoperative management of unsuspected ectopic appendicitis is detailed. The use of a secondary midline incision is recommended if the cecum is not located on the right. Prophylactic appendectomy and fixation of the intestines appear to be warranted if asymptomatic nonrotation is discovered, because of the high incidence of appendiceal perforation as well as later partial small bowel obstruction due to intermittent volvulus.

Author Affiliations
From the Department of Surgery and Trauma Research Unit, Naval Regional Medical Center, San Diego, Calif.

Footnotes
Accepted for publication March 26, 1974.

The opinions or assertions contained herein are those of the authors and are not to be construed as official or reflecting the views of the Navy Department.

Reprint requests to Box 547, CO's Mail Room, Naval Regional Medical Center, Park Blvd, San Diego, CA 92134 (Dr. Smith).

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