Surgical Management of Mesenteric Volvulus Masquerading as Acute Appendicitis: A Case Series of 5 Pediatric Patients

Background: In children, mesenteric volvulus albeit rare, can closely mimic acute appendicitis. This overlap in symptoms (abdominal pain, vomiting, fever) often delays diagnosis, leading to the risk of bowel ischemia. We describe five cases where volvulus was initially mistaken for appendicitis, stressing the need for vigilance in pediatric abdominal emergencies.

Methods: Between 2020 and 2024, five children (ages 2–12) underwent surgery for mesenteric volvulus at my tertiary care pediatric center; after presenting with right-sided abdominal pain and vomiting suggestive of appendicitis. We analyzed their clinical course, imaging results, and surgical outcomes retrospectively.

Results: Initial ultrasounds raised uncertainty in three cases, while one hinted at appendicitis. CT scans, however, spotted the whirlpool sign—a hallmark of volvulus—in all patients. Surgery confirmed twisted bowel segments, with three cases linked to congenital malrotation. Detorsion relieved the twist, and three children required a Ladd’s procedure. One patient lost 20 cm of necrotic bowel, leading to short bowel syndrome. Four recovered smoothly; the fifth needed prolonged nutritional support.

Conclusion: When kids present with appendicitis-like symptoms but unclear imaging, mesenteric volvulus must be ruled out. CT scans are pivotal for spotting the whirlpool sign. Immediate surgery prevents bowel loss, especially in malrotation cases. Clinicians should always keep this rare diagnosis in their list of differentials to avert life-altering complications.