Nigerian Journal of Surgery

: 2016  |  Volume : 22  |  Issue : 1  |  Page : 41--42

Appendicular Torsion

Siddharth Pramod Dubhashi1, Bharat Khadav2,  
1 Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India
2 Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India

Correspondence Address:
Siddharth Pramod Dubhashi
A-2/103, Shivranjan Towers, Someshwarwadi, Pashan, Pune - 411 008, Maharashtra


Torsion of the vermiform appendix is a rare condition detectable only at operation. It can be primary or secondary. This is a case report of 52-year-old female with 180° anti-clockwise rotation of the appendix. Torsion can further leads to strangulation and infarction of the organ. Appendicular torsion could be included in the differential diagnosis of pain in right iliac fossa.

How to cite this article:
Dubhashi SP, Khadav B. Appendicular Torsion.Niger J Surg 2016;22:41-42

How to cite this URL:
Dubhashi SP, Khadav B. Appendicular Torsion. Niger J Surg [serial online] 2016 [cited 2020 Jul 9 ];22:41-42
Available from:

Full Text


Acute appendicitis presents with pain in right iliac fossa. Torsion of the vermiform appendix, though rare, also presents in a similar fashion, and it is detectable only at operation.[1]

 Case Report

A 52-year-old female presented with pain in the right iliac fossa, since 8 days and fever since 3 days. Clinically, the patient was febrile (101°), with tachycardia and guarding in the right iliac fossa with rebound tenderness. Total leucocyte count was 18,300/mm 3. Ultrasonography of abdomen showed only probe tenderness in right iliac fossa. A diagnosis of acute appendicitis was made, and an emergency appendectomy was performed. Intra-operatively, there was evidence of torsion of the vermiform appendix with a counter-clockwise rotation of 180°, around 1.5 cm from the base of the appendix [Figure 1]. The length of the appendix was approximately 8 cm and it appeared to be inflamed. The cut section did not show any remarkable pathology. The postoperative period was uneventful. Histopathology confirmed the diagnosis of acute appendicitis.{Figure 1}


Appendicular torsion first described by Payne in 1918,[2] occurs along with the long axis of the appendix and is located at least 1 cm from its base. The degree of torsion is usually between 180° and 1080°.[3] The direction is most commonly anti-clockwise.[4] The torsion causes luminal obstruction, compromising the blood supply leading to strangulation, and infarction that presents clinically as an acute abdomen.[4] It can be primary or subsequent to other pathological conditions like faecolith, mucocele, carcinoid tumor or lipoma. A fan-shaped mesoappendix with a narrow base, long appendix can cause primary torsion. The site of torsion is variable and could be at the base or about 1 cm or more distal to the base.[5] The present case is of primary torsion with a counter-clockwise rotation. Ultrasound is of little value in diagnosing this condition preoperatively. Uroz-Tristan et al. have mentioned a case in which ultrasonography detected torsion of the appendix along with inflammation.[6] It is uncertain if the inflammation causes the torsion or vice versa.[7] Once the torsion has started, venous obstruction and, later arterial occlusion combine to jeopardize the life of their supplied structure, the presence of bacterial life in a twisted organ might be expected to be especially severe and productive of symptoms and signs, easily distinguished, and of rapidly increasing severity.[8]


Appendicular torsion has a similar clinical presentation like acute appendicitis. Preoperative diagnosis is difficult. This entities could be included in the differential diagnosis of pain in right iliac fossa.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


1Sarin YK, Pathak D. Torsion of vermiform appendix. Indian Pediatr 2006;43:266-7.
2Payne JE. A case of torsion of appendix. Br J Surg 1918;6:327.
3Tzilinis A, Vahedi MH, Wittenborn WS. Appendiceal torsion in an adult: Case report and review of the literature. Curr Surg 2002;59:410-1.
4Val-Bernal JF, González-Vela C, Garijo MF. Primary acute torsion of the vermiform appendix. Pediatr Pathol Lab Med 1996;16:655-61.
5Lee CH, Lee MR, Kim JC, Kang MJ, Jeong YJ. Torsion of a mucocele of the vermiform appendix: A case report and review of the literature. J Korean Surg Soc 2011;81 Suppl 1:S47-50.
6Uroz-Tristan J, García-Urgelles X, Poenaru D, Avila-Suarez R, Valenciano-Fuentes B. Torsion of vermiform appendix: Value of ultrasonographic findings. Eur J Pediatr Surg 1998;8:376-7.
7Bestman TJ, van Cleemput M, Detournay G. Torsion of the vermiform appendix: A case report. Acta Chir Belg 2006;106:228-9.
8Carter AE. Torsion of the appendix. Postgrad Med J 1959;35:671-2.