Appendicitis presenting as LUQ pain in an anatomically normal patient: a case study

Baillie W. C. Ferris


Appendicitis typically presents with right sided pain, but some patients present with left sided symptoms. This is most commonly due to anatomical abnormalities such as intestinal malrotation or Situs Inversus. In this case study I present a case where an anatomically normal patient presented with Left Upper Quadrant (LUQ) pain. I hypothesize that the reason for this is incorrect interpretation of visceral nociceptive afferents by the Central Nervous System (CNS). I review the literature in regard to the “visceral homunculus.” I also review the literature with regards to left sided ab-domical pain and Appendicitis. This case highlights the importance of considering Appendicitis in LUQ pain.


Appendicitis, Left upper quadrant, Mucocele

Full Text:



Miettinen, Pasanen P, Latrinen P, Alhava JE. Acute abdominal pain in adults. Ann Chir Gynaecol. 1996;85(1):5-9.

Akbulut S, Caliskan A, Ekin A, Yagmur Y. Left-sided acute appendicitis with situs inversus totalis: review of 63 published cases and report of two cases. J Gastrointestinal Surg. 2010;14(9):1422-8.

Irvin TT. Abdominal pain: a surgical audit of 1190 emergency admissions. Br J Surg. 1989;76(11):1121.

Akbulut S, Ulku A, Senol A, Tas M, Yagmur Y. Left-sided appendicitis: review of 95 published cases and a case report. World J Gastroenterol. 2010;16(44):5598-602.

Nordt SP, Bowns C, Moran J, Kelleher, Brendan. Swadron, Stuart. Left Upper Quadrant Abdominal Pain. West J Emerg Med. 2012.13(6). Available at:

Aziz Q, Thompson DG, Ng VW, Hamdy S, Sarkar S, Brammer MJ, et al. Cortical processing of human somatic and visceral sensation. J Neuro Sci. 2000;20(7):2657-63.

Foreman RD, Blair RW, Weber RN. Viscerosomatic convergence onto T2–T4 spinoreticular, spinoreticular-spinothalamic, and spinothalamic tract neurons in the cat. Experimental neurology. 1984;85(3):597-619.

Traub RJ, Sengupta JN, Gebhart GF. Differential c-fos expression in the nucleus of the solitary tract and spinal cord following noxious gastric distention in the rat. Neuroscience. 1996;74(3):873-84.

Bruggemann J, Shi T, Apkarian AV. Squirrel monkey lateral thalamus. II. Viscerosomatic convergent representation of urinary bladder, colon, and esophagus. J Neuro Sci. 1994;14(11):6796-814.

Drewes AM, Dimcevski G, Sami SA, Funch-Jensen P, Huynh KD, Le Pera D, et al. The “human visceral homunculus” to pain evoked in the oesophagus, stomach, duodenum and sigmoid colon. Experimental brain research. 2006;174(3):443-52.