Torsion of the appendix

First report

"On Monday, March 13, 1916, while travelling in a train, [the patient] was seized with sudden pain in the epigastrium after lunch. She vomited several times, but the pain continued and was of a colicky nature. At midnight the pain suddenly shifted to the right iliac fossa and became continuous.

The following day a doctor was called in; he ordered enemata, and three were given, with very copious results. On the 15th I saw the patient and operated the same evening.

On opening the abdomen through the right rectus incision, the appendix was found pointing downwards and slightly outwards in the right iliac fossa. It was quite free except for a slight recent adhesion from the extreme tip to the iliac fossa. On examination it was found to be twisted, and it took three complete turns to unravel it . . . The appendix distal to the narrowing caused by the twisting was gangrenous, and the meso-appendix dark and swollen. The appendix was removed, and the abdomen drained through the original incision. The temperature and pulse became normal on the third day, and the patient made an uneventful recovery.

Remarks. — The appendix was 21/2 in. long and contained faecal material. It seems most probable that the previous attacks were due to a 'constipated appendix,' and that the torsion resulted from irregular peristaltic movements on the part of the appendix itself."

— Br J Surg 1918; 6: 327