Unexpected right-sided sigmoid colon in laparoscopy: A case report and review of literature

Background: The presence of a right-sided sigmoid colon is a rare anatomical variation usually discovered incidentally during surgical interventions. This case report details an unexpected right-sided sigmoid colon identified during a laparoscopic appendectomy and examines the pertinent literature to explore its clinical importance.

Case summary: A 71-year-old woman presented with acute appendicitis. A preoperative computed tomography (CT) scan showed peri-appendiceal inflammation but no significant anatomical abnormalities. During laparoscopic surgery, an unexpected finding was encountered: The sigmoid colon was situated on the right side and exhibited an abnormal relationship with the cecum and ascending colon. Postoperative pathological examination confirmed appendicitis with no additional pathological findings. The right-sided sigmoid colon anomaly was verified through intraoperative assessment and later re-evaluation with CT and colonographic imaging. The patient underwent a laparoscopic appendectomy and experienced a smooth postoperative recovery.

Conclusion: This case highlights the necessity of being attentive to anatomical variations during laparoscopic surgery, particularly when managing appendicitis. A review of the literature indicated that the occurrence of a right-sided sigmoid colon is infrequent and may be associated with anomalies in midgut rotation during embryonic development. Awareness of this variation can help prevent surgical complications and inform future clinical practice.