Internal Herniation Due to Appendix Vermiformis Rotation: A Rare Case of an Acute Abdomen

Internal herniation is a rare occurrence that appears in about 0.2-0.9% of autopsy cases. An 84-year-old female patient presented to our clinic with severely distended the abdomen .Abdominal examination revealed tenderness and rebound mainly in the right side of the abdomen. Following the laparatomy it was observed that the appendix vermiformis was about 12 cm in length and was adhered to the cecum having rotated around itself at 360 degrees. It was also seen that a terminal ileum loop of about 30 cm. had penetrated into the appendix forming a circle having rotated around itself and that this segment was ischemic and a portion was perforated for a length of 1 cm. Further, this rotation had also affected the cecum which showed ischemic changes. A right hemilectomy and segmenter small bowel resection were performed. There were no problems during the follow-ups the patient was discharged on the tenth postoperative day. Although there are several reports detailing various kinds of internal herniation published in literature.