Left-sided perforated appendicitis in a 22-year-female with intestinal malrotation: A case report from a resource-limited setting.

Introduction and importance: A left-sided appendicitis is rare and usually caused by congenital anomalies such as intestinal malrotation or situs inversus. Diagnosis can be particularly challenging in low-resource settings where imaging such as CT is unavailable. Presentation of case: A 22-year-old female presented with periumbilical pain that migrated to left iliac fossa area over five days. Due to the lack of CT imaging, clinical evaluation led to a diagnosis of acute abdomen. Emergency laparotomy revealed a perforated appendix located in the left lower quadrant due to intestinal malrotation. Appendectomy was performed, and the patient recovered uneventfully. Her last menstrual period was one week before admission, and gynecologic causes were considered in the differential diagnosis but excluded intraoperatively. Clinical discussion: As a result of this case, appendicitis should be considered in the differential diagnosis of left-sided abdominal pain. The intraoperative recognition of malrotation emphasizes the importance of surgical awareness of anatomical variations, particularly when preoperative imaging is lacking. Conclusion: The diagnosis of left-sided perforated appendicitis is rare, but should be considered in patients with atypical abdominal pain. In resource-limited environments, clinical judgment and timely surgical exploration are essential.