EP.TU.260Retained appendiceal tip and abdominal wall appendicolith - a rare combination of post appendicectomy complications

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Abhishek Dey ◽  
Nicholas Symons
Keyword(s):  
Abdominal Wall ◽  
Iliac Fossa ◽  
Symptomatic Relief ◽  
Radiological Investigation ◽  
Complete Excision ◽  
Rare Combination ◽  
Abdominal Wall Abscess ◽  
Right Iliac Fossa Pain ◽  
The Right ◽  
Inflammatory Changes

Abstract Appendicitis involving the appendix stump is a recognised post appendicectomy complication but the same involving the appendiceal tip is rare. Similarly, abdominal wall abscess secondary to retained appendicolith is also infrequently encountered. Our case highlights a rare combination of both complications arising separately. An 29 year-old man presented with 3 days of generalised malaise and progressively worsening right iliac fossa pain some ten months after a laparoscopic appendicectomy. This had been complicated by residual right iliac fossa inflammation that was treated conservatively and serial scans demonstrated gradually resolving inflammation. He also had well controlled ulcerative colitis. On examination, he was noted to be pyrexial with a tender fluctuant mass in the right flank. An ultrasound scan demonstrated inflammatory changes in the abdominal wall with no intra-abdominal collections. A diagnostic laparoscopy found an inflamed appendix tip, attached to the residual mesoappendix and embedded in the abdominal wall behind the mid-ascending colon. A completion appendicectomy was performed. The patient recovered well but returned 4 months later with persistent pain and a fluctuant mass over the right iliac fossa. Radiological investigation revealed an abdominal wall collection containing a calcified appendicolith. The collection was refractory to ultrasound guided drainage and an exploration of the abdominal wall allowed extraction of the appendicolith followed by symptomatic relief. This case emphasizes the importance of complete excision of the appendix and extraction of debris, which can be challenging when the appendix lies in a retro-colic position.

scholarly journals 956 Retained Appendiceal Tip and Abdominal Wall Appendicolith - A Rare Combination of Post Appendicectomy Complications

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Dey ◽  
N Symons
Keyword(s):  
Abdominal Wall ◽  
Iliac Fossa ◽  
Symptomatic Relief ◽  
Radiological Investigation ◽  
Complete Excision ◽  
Rare Combination ◽  
Abdominal Wall Abscess ◽  
Right Iliac Fossa Pain ◽  
The Right ◽  
Inflammatory Changes

Abstract Appendicitis involving the appendix stump is a recognised post appendicectomy complication but the same involving the appendiceal tip is rare. Similarly, abdominal wall abscess secondary to retained appendicolith is also infrequently encountered. Our case highlights a rare combination of both complications arising separately. A 29-year-old man presented with 3 days of generalised malaise and progressively worsening right iliac fossa pain some ten months after a laparoscopic appendicectomy. This had been complicated by residual right iliac fossa inflammation that was treated conservatively and serial scans demonstrated gradually resolving inflammation. He also had well controlled ulcerative colitis. On examination, he was noted to be pyrexial with a tender fluctuant mass in the right flank. An ultrasound scan demonstrated inflammatory changes in the abdominal wall with no intra-abdominal collections. A diagnostic laparoscopy found an inflamed appendix tip, attached to the residual mesoappendix and embedded in the abdominal wall behind the mid-ascending colon. A completion appendicectomy was performed. The patient recovered well but returned 4 months later with persistent pain and a fluctuant mass over the right iliac fossa. Radiological investigation revealed an abdominal wall collection containing a calcified appendicolith. The collection was refractory to ultrasound guided drainage and an exploration of the abdominal wall allowed extraction of the appendicolith followed by symptomatic relief. This case emphasizes the importance of complete excision of the appendix and extraction of debris, which can be challenging when the appendix lies in a retro-colic position.

scholarly journals CLINICAL STUDY OF PAIN IN RIGHT ILIAC FOSSA

2020 ◽  
Vol 4 (8) ◽  
Author(s):  
Saurabh Kothari ◽  
Manjula Kothari ◽  
Shree Mohan Joshi ◽  
Kalp Shandilya
Keyword(s):  
Iliac Fossa ◽  
Signs And Symptoms ◽  
Clinical History ◽  
X Ray ◽  
Pain Abdomen ◽  
Detailed Clinical History ◽  
Right Iliac Fossa Pain ◽  
Chest X Ray ◽  
The Right ◽  
Appendicular Mass

Background: A mass in the right iliac fossa is a common diagnostic problem encountered in clinical practice, requiring skill in diagnosis. Methods: 100 patients with signs and symptoms of right iliac fossa mass admitted in Hospital were identified and were studied by taking detailed clinical history, physical examination and were subjected to various investigations like x ray erect abdomen, chest x-ray, contrast x-ray . Result: In this study of out of 100 cases, 65.00% of cases were related to appendicular pathology either in the form of appendicular mass or appendicular abscess. There were 12.00% cases of ileocaecal tuberculosis. Conclusion: Appendicular lump remains the most common cause for right iliac fossa pain. Ileocaecal tuberculosis is one of the most important differential diagnoses for pain abdomen. Keywords: Appendicular Mass, Ileocaecal Tuberculosis, Carcinoma Caecum, Right Iliac Fossa Mass.

Torsion of a parasitic leiomyoma: a rare but important differential in women presenting with lower abdominal pain

2021 ◽  
Vol 14 (1) ◽  
pp. e232797
Author(s):  
Clemmie Stebbings ◽  
Ahmed Latif ◽  
Janakan Gnananandan
Keyword(s):  
Abdominal Pain ◽  
Iliac Fossa ◽  
Lower Abdominal Pain ◽  
Sudden Onset ◽  
Greater Omentum ◽  
Caribbean Woman ◽  
History Of ◽  
Right Iliac Fossa Pain ◽  
The Right ◽  
Fat Stranding

A 39-year-old multiparous Afro-Caribbean woman attended the emergency department with sudden-onset severe right iliac fossa pain. Her inflammatory markers were mildly elevated. Computerised tomography of the abdomen demonstrated features of fat stranding in the right iliac fossa suspicious of acute appendicitis. The scan also noted uterine leiomyomas. The patient was taken to theatre for an emergency diagnostic laparoscopy where her appendix was found to be macroscopically normal. A necrotic heavily calcified parasitic leiomyoma was seen in the right adnexa, free of the uterus and adherent to the greater omentum on a long torted pedicle. The parasitic leiomyoma was successfully removed piecemeal laparoscopically. Complications of leiomyomas, namely, torsion and necrosis, are important differentials in women presenting with sudden-onset lower abdominal pain. A history of sudden-onset severe lower abdominal pain with a background of known leiomyoma should prompt the clerking surgeon to consider a complication of leiomyoma as part of the differential diagnoses.

scholarly journals The Clinical Aspect of Congenital Mesenteric Malformation in Children

1928 ◽  
Vol 21 (10) ◽  
pp. 1717-1723
Keyword(s):  
Functional Disability ◽  
Clinical Investigation ◽  
Pathological Condition ◽  
Iliac Fossa ◽  
Clinical Aspect ◽  
Special Method ◽  
Physical Sign ◽  
Chronic Type ◽  
Radiological Investigation ◽  
The Right

(1) Congenital malformations of the mesentery are a definite morbid entity of a chronic type which may be recognized, before operation, by careful clinical investigation. (2) The symptom-complexes to which they give rise cannot be explained by reference to any of the well-known abdominal surgical diseases; still less by any purely functional disability which may be included under the term “indigestion.” (3) The most important physical sign is the “emptiness” of the right iliac fossa, associated sometimes with an asymmetrical enlargement of the abdomen on the left side. These signs follow of necessity, inasmuch as the whole segment of the embryonic mid-gut is involved in a failure of rotation and fixation after reduction from the umbilical sac. (4) Radiological investigation should prove to be more helpful in confirming the clinical diagnosis when the special method of examination already described is used as a routine. (5) Operative treatment may cure the patient; alternatively it may reveal a pathological condition for which a rational course of treatment may be drawn up subsequently, when the precise details of the malformation have been discovered.

scholarly journals P118 The 134-year-old problem meets the 1-year-old problem: lessons learned in managing acute appendicitis during the COVID era

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Sherwin Fernando ◽  
Diwakar Ryali Sarma ◽  
Sherwin Fernando
Keyword(s):  
Pain Treatment ◽  
Iliac Fossa ◽  
Lessons Learned ◽  
Open Approach ◽  
Patient Demographics ◽  
Right Iliac Fossa Pain ◽  
American Society ◽  
The Uk ◽  
The Right

Abstract Introduction The Right Iliac Fossa Pain Treatment (RIFT) study highlighted the rate of negative appendicectomies in the UK as one third of all procedures. However, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2/COVID) pandemic has changed surgical practice. New practices in the COVID era have changed the rate of negative appendicectomies. Methods A retrospective analysis was conducted of patients admitted with appendicitis from March 2020 to June 2020. Patient Demographics 58 patients were identified, 43 (74%) were adults and 15 (26%) were children. The median age of the adults was 33 (range 18-80) and the median American Society of Anaesthetists (ASA) grading was 1. The median age of children was 11 (range 4-17) and all were ASA grade 1. Results 73.8% (31) of adult patients had a Computerised Tomography (CT) scan as part of their workup. 40% of paediatric patients underwent an ultrasound scan of the abdomen whilst the remaining 60% were diagnosed clinically. The open approach was favoured in both cohorts (39.5% and 46.7% respectively). No negative appendicectomies were performed. Conclusion COVID19 has changed practice resulting in better outcomes for colorectal units. Further studies (COVID SURG and COVID HAREM) are needed to fully assess the role of imaging in reducing the number of negative appendicectomies.

scholarly journals Cholecystocutaneous Fistula Associated with Necrotizing Fasciitis of the Abdominal Wall: A Case Report

2020 ◽  
pp. 1-5
Author(s):  
Marcelo Ribeiro ◽  
Victoria Accioly Russowsky ◽  
Marcelo Ribeiro ◽  
Murillo Lima Favaro ◽  
Stephanie Santin ◽  
...  
Keyword(s):  
Necrotizing Fasciitis ◽  
Abdominal Wall ◽  
Rare Complication ◽  
Iliac Fossa ◽  
Left Hypochondrium ◽  
Serious Infection ◽  
Progressive Necrosis ◽  
Aggressive Surgical Approach ◽  
Frequent Site ◽  
The Right

Cholecystocutaneous fistula represents an extremely rare complication of calculous cholecystopathy. In the past 50 years, less than 50 cases have been reported. The most frequent site of spontaneous cholecystocutaneous fistula is the right hypochondrium, followed by the left hypochondrium, periumbilical, right lumbar, right iliac fossa and gluteal areas. The association with necrotizing fasciitis that represents a serious infection, characterized by extensive and rapidly progressive necrosis, affecting the subcutaneous plane and reaching the muscular fascia provides a high mortality rate and extensive procedures are required. Herein we present a case of a 64-years-old, female, admitted to the emergency department with complaint of diffuse, severe abdominal pain, associated with a tense and painful lesion in the abdominal wall with the diagnose of cholecystocutaneous fistula associated with necrotizing fasciitis that despite an aggressive surgical approach developed a multisystem failure and died 24 hours after admission.

scholarly journals A rare case of Valentino’s syndrome

2018 ◽  
Vol 5 (8) ◽  
pp. 2933
Author(s):  
Mohan C. P. ◽  
Kabalimurthy J. ◽  
Balamurugan E. ◽  
Jayavarmaa R.
Keyword(s):  
Acute Appendicitis ◽  
Rare Case ◽  
Iliac Fossa ◽  
Duodenal Perforation ◽  
Peptic Ulcer Perforation ◽  
Gastric Contents ◽  
Right Iliac Fossa Pain ◽  
The Right ◽  
Clinical Conditions

The pain in the right iliac fossa corresponds with many clinical conditions, most commonly Acute appendicitis. Rarely peptic ulcer perforation presents as pain in the right iliac fossa. This condition is called as Valentino’s syndrome. This is due to the leakage of the gastric contents from the stomach or duodenum during the perforation. This induces peritonitis and sometimes the fluids get collected in the right iliac fossa causing pain, hence mimicking appendicitis. This is the case study of a 17yr old boy with right iliac fossa pain and tenderness, vomiting, fever, all corresponding to acute appendicitis. But on surgical exploration, it was found to be duodenal perforation. Valentino’s syndrome is a very misleading condition which will lead to death if proper evaluation and timely management is not done. This study emphasis the fact that Valentino’s syndrome has to be considered as the differential diagnosis in symptoms suggestive of acute appendicitis.

scholarly journals ABDOMINAL WALL METASTASIS OF HEPATOCELLULAR CARCINOMA-AN UNUSUAL PRESENTATION.

2020 ◽  
pp. 52-53
Author(s):  
Mehveen Rahim Khan ◽  
Nabila Afsar ◽  
Idrees Akhter Afroze
Keyword(s):  
Hepatocellular Carcinoma ◽  
Abdominal Wall ◽  
Iliac Fossa ◽  
Unusual Presentation ◽  
Desmoid Tumour ◽  
Abdominal Wall Metastasis ◽  
The Right

We report a case of 60 year old male with a swelling in the right iliac fossa which presented as desmoid tumour clinically and was later found to be metastasis from hepatocellular carcinoma.

scholarly journals Parasitic Myoma: A Very Rare Case Report aAnd Review of Literature

2019 ◽  
Vol 17 (1) ◽  
pp. 50-53
Author(s):  
Md Manir Hossain Khan ◽  
Jobaida Sultana
Keyword(s):  
Abdominal Wall ◽  
Blood Supply ◽  
Iliac Fossa ◽  
Abdominal Cavity ◽  
Low Grade ◽  
Review Of Literature ◽  
Rare Case Report ◽  
History Of ◽  
The Right ◽  
Further Development

A 32 years old unmarried women presented with periumbilical colickey abdominal pain which shiftted to the right iliac fossa with anorexia, vomiting and low grade fever. She had history of open myomectomy 4 years back for menorrhagia with multiple fibroids (myomas). On examination, the pointing sign, Rovsing's sign, McBurney's sign &Blumberg's sign were positive. Then she was diagnosed as a case of acute appendicitis. Ultrasonography revealed nothing significant. Appendicectomy was done through right Grid Iron incision. Appendix was found inflammed, swollen and there was collection of fluid in the peritoneal cavity. During closure, incidentally a solid mass about 5 ><4 ><2.5 cm was found exterior to the peritoneum near the incision at the abdominal wall. The mass was excised. Subsequently histopathotology confirmed a leiomyoma (Myoma or parasitic fibroid). The parasitic myoma may develop spontaneously as pedanculatedsubcerousmyomaloose their uterine blood supply or iatrogenically from retained fragment of myoma from previous myomectomy or hysterectomy and get blood supply from abdominal wall. Even small bits displaced into the abdominal cavity can result in parasitic fibroids. This case is reported here to give emphasis on the surveilence of parasitic myoma during myomectomy or hysterectomy for fibroid uterus and all tissue pieces that are morcellated should be delligently removed for the prevention of further development of parasitic myoma. Journal of Surgical Sciences (2013) Vol. 17 (1) : 50-53

scholarly journals Appendiceal Crohn’s disease: a rare differential of right iliac fossa pain

2020 ◽  
Vol 13 (2) ◽  
pp. e232549
Author(s):  
Adam James Crellin ◽  
Omar Musbahi ◽  
Natasha Onwu ◽  
Sandeep Singh
Keyword(s):  
Crohn’S Disease ◽  
Abdominal Pain ◽  
Crohn's Disease ◽  
Iliac Fossa ◽  
Right Hemicolectomy ◽  
Emergency Unit ◽  
Good Recovery ◽  
History Of ◽  
Right Iliac Fossa Pain ◽  
The Right

A 30-year-old man with a history of severe right iliac fossa pain was referred to the surgical emergency unit. His symptoms began 3 days prior as mild, non-specific abdominal pain which progressively localised to the right iliac fossa and worsened in severity. Investigations were suggestive of acute appendicitis, and therefore a laparoscopic appendicectomy was planned. Laparoscopy revealed a thickened, necrotic appendix with a mass at the base of the appendix, in keeping with the appearance of an appendiceal malignancy. Subsequently a right hemicolectomy was performed. Histology revealed active chronic inflammation and granulomas highly suggestive of appendiceal Crohn’s disease. Since, the patient has made a good recovery and presently shows no further signs of Crohn’s disease. This case is demonstrative of one of many rare findings on histological examination of the appendix. It emphasises the need for a wide differential when investigating right iliac fossa pain.

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