Torsion of the appendix

Amy L Moten and Randal S Williams
Med J Aust 2002; 177 (11): 632. || doi: 10.5694/j.1326-5377.2002.tb04990.x
Published online: 9 December 2002

Torsion of the vermiform appendix was first reported by Payne1 in 1918 and remains something of a curiosity, with only 19 further cases reported, 12 in paediatric patients.2,3

Anatomical variations (eg, long mesoappendix), appendiceal tumours and strenuous physical exercise such as calisthenics were suggested to predispose to torsion.4,5

Reported clinical presentations were indistinguishable from acute appendicitis.4

Our patient, a 44-year-old woman, suddenly developed severe abdominal pain while walking, which was unrelieved by narcotic analgesics. Abdominal palpation revealed acute tenderness suprapubically and in the right iliac fossa.

Surgical exploration via the standard McBurney incision revealed a dilated gangrenous appendix twisted 360 degrees anticlockwise at its base, as shown in the operative photograph.

Histopathological examination of the appendix revealed a cystadenoma close to its distal end.

The patient made an uncomplicated recovery after appendicectomy.

  • Amy L Moten1
  • Randal S Williams2

  • 1 University of Adelaide, Adelaide, SA.
  • 2 Modbury Public Hospital, Modbury, SA.


  • 1. Payne JE. A case of torsion of the appendix. Br J Surg 1918; 6: 327.
  • 2. Val-Bernal JF, Gonzalez-Vela C, Garijo MF. Primary acute torsion of the vermiform appendix. Pediatr Pathol Lab Med 1996; 16: 655-661.
  • 3. Uroz-Tristan J, Garcia-Urgelles X, Poenaru D, et al. Eur J Paediatr Surg 1998; 8: 376-377.
  • 4. Merrett ND, Lubowski DZ, King DW. Torsion of the vermiform appendix. A case report and review of the literature. Aust N Z J Surg 1992; 62: 981-983.
  • 5. Gilchrist BF. Torsion of the appendix. J Paediatr Surg 1995; 30: 901-902.


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