BACKGROUND: There are a lot of different causes of abdominal pain; in this case, 
a young woman suffers from three diseases with similar symptoms. Adult 
intestinal mal-rotation is a rare condition of deviation from the normal 270° 
counter clockwise rotation of the midgut resulting in, not only mal-position of 
the small intestine, but also mal-fixation of the mesentery. Fitz-Hugh-Curtis 
syndrome is a rare complication of pelvic inflammatory disease; it involves 
liver capsule inflammation associated with genital tract infection, which is 
usually caused by Neisseria gonorrhoea and Chlamydia trachomatis. Neuroendocrine 
tumors are enterochromaffin cell neoplasms that arise from cells of the 
endocrine (hormonal) and nervous systems; the appendicular one is the most 
common primary malignant lesion of these tumors, it's incidence is about 0.3 - 
0.9% of appendectomies done. Just for knowledge, this is the first described 
case of concomitant presence of all these diseases with clinical symptoms 
attributable to each one.
CASE PRESENTATION: 40-years-old woman suffers from acute abdominal pain, 
predominantly on the right quadrants, without abdominal distension, no guarding 
nor rigidity and normal intestinal peristalsis. She has a long history of 
abdominal intermittent pain, with cramps every 30-40 min, resolving 
spontaneously. She was diagnosed as intestinal mal-rotation through computed 
tomography scan which has evidenced a mobilized intra--peritoneal duodenum with 
cecum/ascending colon predominately lying on the left side and the small 
intestine almost entirely lying on the right side of abdomen, without evidence 
of effusion, edema or signs of intestinal ischemia or infarction. Exploratory 
laparoscopy demonstrated an inflammatory process in the hepatic-renal space, 
with bloody adhesions above the liver capsule; this is additional to the typical 
pelvic inflammatory disease signs (Fitz-Hugh-Curtis syndrome). Appendectomy was 
performed with histological analysis resulting in appendicular neuroendocrine 
tumor.
CONCLUSIONS: Although the patient has an intestinal mal-rotation which could 
explain the abdominal painful symptoms, it is not possible to exclude other 
concomitant causes, such as perihepatitis on pelvic inflammatory disease or 
neuroendocrine tumors. Even if all these diseases are rarely seen in daily 
clinical practice, they should be considered in the differential diagnosis of 
chronic intermittent abdominal pain in a young woman.