Torsion of the appendix mimicking ovarian torsion

BACKGROUND: Appendiceal torsion is rare and generally seen more frequently in children than adults. Untreated it can lead to necrosis, ulceration, and subsequent peritonitis. CASE: A middle-aged female presented with a 5-day history of cramping abdominal pain and nausea and vomiting. Abdominal wall guarding and rebound tenderness was noted on examination. Computerized tomography showed an 8 x 4 cm mass anterior to the uterus, suggestive of degenerating fibroid versus ovarian dermoid cyst. Laparoscopy was performed for presumed ovarian torsion. Torsion of the appendix was discovered and treated by laparoscopic appendectomy. CONCLUSION: Patients with presumed ovarian torsion should undergo urgent laparoscopy for diagnosis and attempted ovarian salvage. The possibility of conditions that may require different surgical interventions, such as appendiceal torsion, should be considered.